RX/DWO Validation coming soon! You asked and we answered! We are getting close to expanding the Doc Validation requirements to the RX/DWO document. This will help us catch errors on the orders prior to submission.

It’s an exciting time at NSM as we pilot new tools to help that utilize both Robotic Process Automation (RPA or BOTs) and AI:

Pilot 1: The next phase is here! We are using Rosey the BOT to retrieve payer decisions via Availity for 12 specific payers and downloading the responses directly into Mobility Advisor, significantly reducing the time spent manually logging into Availity to locate payer response. With the uploads into Mobility Advisor, we are implementing steps for Auth Validation that notify us when a payer response is scanned that requires review and validation prior to proceeding.

Pilot 2: We are using AI to review medical documentation for HCPCS E1161, K0005, K0856 and K0861 to ensure it meets Medicare coverage criteria. The goal is to decrease denials/deferrals by ensuring accurate documentation is on file, while also reducing the time it takes the funding team to review and validate documentation. A big thank you to pilot teammates Kent Phillips, Linnae Farrugello, Sarah Kirchoff, Vivian Sena!

Ushur PPQA Pilot is here! We are working on using Ushur AI to send text messages to our clients after submission and before PPQA, confirming their insurance, address, and place of residence hasn’t, or will not change, in hopes of limiting equipment we purchase that cannot be delivered due to one of these reasons. We just kicked off the pilot 2/17/2025 and are looking forward to expanding this process and technology to more locations soon.

We are also still working on the following larger system enhancements once the above automation is in place:

Client Responsibility Collection Improvement - Create process and system improvement for client responsibility communication and collection which includes summary screen update and automation that will help prevent/reduce FARs and delays for our clients.

Crossover/Supplement Payer Improvement - Improved process that will introduce automation of the payer submission/authorization dates to mirror primary when we’ve identified a payer is a true crossover or supplemental payer.