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Related Experiment Video

Updated: Apr 4, 2026

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Robotic process automation for identifying missing codes on insurance claims.

Jiyun Lee1, Jun Hwan Cho2, Won Joo Lee1

  • 1Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Korea (the Republic of).

BMJ Health & Care Informatics
|April 2, 2026
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Summary

Robotic process automation (RPA) significantly improved insurance claim audits by enhancing accuracy and reducing processing time by 55%. This digital transformation offers a scalable solution for healthcare administration.

Keywords:
Electronic Health RecordsMedical Informatics Applications

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Area of Science:

  • Healthcare Administration
  • Health Informatics
  • Process Automation

Background:

  • Insurance claim post-review involves repetitive, rule-based administrative tasks.
  • Manual review processes are prone to errors and time-consuming.
  • Tertiary hospitals face challenges in efficiently managing large volumes of insurance claims.

Purpose of the Study:

  • To develop and implement Robotic Process Automation (RPA) for identifying missing codes in insurance claims.
  • To evaluate the feasibility and effectiveness of RPA in a tertiary hospital setting.
  • To compare the accuracy and efficiency of RPA with manual claim review processes.

Main Methods:

  • A single-centre, operational implementation of an RPA system using Blue Prism.
  • Integration of RPA with Optical Character Recognition (OCR) and Electronic Medical Record (EMR) platforms.
  • Comparison of RPA performance against manual review for accuracy and processing time.

Main Results:

  • The RPA system analyzed 61 claim statements and performed 199 OCR processes.
  • Google Cloud Vision API achieved 100% detection accuracy for code identification.
  • RPA reduced average processing time by 55%, from 120 to 54 minutes per claim.

Conclusions:

  • RPA reliably automates repetitive administrative tasks, enhancing accuracy and standardization in insurance claim audits.
  • The developed RPA system demonstrated feasibility within complex healthcare workflows and ensured data protection compliance.
  • Implementing RPA offers a scalable model for digital transformation in healthcare administration, reducing workload and improving efficiency.