Healthcare Use Cases

1. Patient Intake and Triage Process

Business Scenario

A large metropolitan hospital implementing an efficient patient intake and triage system to reduce wait times and improve patient flow.

Process Overview

Key Process Details

Stage	Description	Duration	Key Actors
Registration	Patient information capture	10-15 mins	Intake Coordinator
Insurance Verification	Coverage and eligibility check	15-30 mins	Insurance Specialist
Symptom Assessment	Initial health screening	15-30 mins	Triage Nurse
Patient Routing	Determine treatment priority	10-20 mins	Triage Team

2. Insurance Claims Processing

Business Scenario

A health insurance provider streamlining claims processing to reduce turnaround time and improve customer satisfaction.

Process Overview

Key Process Details

Stage	Description	Duration	Key Actors
Initial Submission	Claim document receipt	1-2 hours	Claims Portal
Validation	Document completeness check	4-8 hours	Claims Processor
Review	Detailed claim assessment	1-3 days	Claims Analysts
Determination	Approve or deny claim	3-5 days	Claims Committee

3. Treatment Authorization Process

Business Scenario

A healthcare network developing a standardized process for treatment and procedure authorizations.

Process Overview

Key Process Details

Stage	Description	Duration	Key Actors
Initial Request	Treatment recommendation	1-2 hours	Treating Physician
Medical Necessity Evaluation	Clinical criteria assessment	1-2 days	Medical Review Team
Authorization	Approval or denial process	2-5 days	Authorization Committee
Scheduling	Treatment coordination	1-3 days	Care Coordinator

Business Value Proposition

These use cases demonstrate how process automation can: - Reduce administrative overhead by 40-60% - Improve patient experience and satisfaction - Enhance accuracy of medical documentation - Accelerate claims and authorization processes - Provide comprehensive tracking and reporting - Ensure compliance with healthcare regulations - Minimize human error in critical processes