Secure automation streamlines hospital claim reviews and lays foundation for AI
Key takeaways
Health care organizations face increasing pressure to modernize their revenue cycle while maintaining the highest standards of security and data protection. Manual reviews of claim status slow down workflows, increase administrative burden and limit scalability. Reliance on third-party cloud solutions introduces additional risk—creating exposure to outages, breaches and operational disruptions.
Following a major industry incident that underscored these vulnerabilities, a large multi-facility health system turned to RSM US LLP to help rebuild their claims infrastructure, remove operational bottlenecks, and establish a secure, scalable foundation for automation and future artificial intelligence adoption.
Client challenges
The organization faced several urgent challenges:
Leadership required a solution that delivered immediate efficiency gains, stronger security and a measurable return on investment.
Building revenue cycle automation
The engagement began with a strategic collaboration between RSM and Microsoft, built on a shared commitment to accelerate the health system’s modernization goals. By leveraging Microsoft’s co-funding programs, RSM was able to neutralize budget barriers and demonstrate a clear, low-risk path to innovation.
RSM facilitated a series of strategic ideation workshops, at no cost to the client, giving leadership space to explore modernization opportunities and unify around a forward-looking roadmap. These sessions highlighted how automation could improve performance immediately while also preparing the organization for emerging AI capabilities.
At the core of the proposed solution was a Microsoft Azure-based private clearinghouse, engineered to provide:
- Direct, secure communication with payers
- Automated claim-status retrieval
- Epic-integrated workflow updates
- A resilient integration layer built for future AI-driven automation
This approach helped ensure that even though the initial implementation was driven by automation rather than AI, the architecture could seamlessly support upcoming capabilities such as denial prediction, document classification and automated prior authorization.
Solution overview
Working closely with the client, RSM designed and implemented a secure, Azure-native automation solution that retrieves claim-status updates directly from payer portals and integrates them into the Epic system, reducing manual work and improving cycle times. Services delivered included:
- Strategic ideation and roadmap development (codeveloped with Microsoft)
- Azure-based architecture and security design
- Automated claim-status retrieval and Epic integration
- Revenue cycle workflow mapping and optimization
- Risk mitigation and system hardening
- User training and enablement for sustained adoption
The system now processes approximately 15 million claims per year, including some Medicare claims, many of which were not handled by the client’s previous vendor.
Impact and outcomes
Microsoft’s involvement served as both a financial and a strategic catalyst. Co-funding reduced perceived risk and accelerated executive buy-in, while joint engagement with RSM increased confidence in the solution approach. Key outcomes included:
- Eliminated third-party dependencies costing $1.3 million per year
- Saved 20,000 of labor hours per year across the revenue cycle team
- Expected to realize 7:1 benefit-to-cost ratio over two years
- Reduced manual claim status checks by more than 95%, accelerating reimbursements and improving staff productivity
- Enhanced security with Azure-native controls and direct payer integration, reducing exposure to external vulnerabilities
- Enabled rapid deployment of future automation and upcoming AI capabilities across the revenue cycle