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Substantial ROI Achieved by Automating Insurance Eligibility Verification in Meditech​

SphereGen Case Study

Determining insurance eligibility is an important part of the claims billing process. If eligibility is not verified, claims may be denied and reimbursement delayed, significantly affecting the revenue cycle.​

Our client automated their eligibility verification process and realized substantial ROI as a result. Read how SphereGen helped their client reduce the length of their payment cycle by automating the insurance eligibility verification process in Meditech.

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Substantial
ROI Achieved
by Automating Insurance Eligibility Verification in Meditech​

SphereGen Case Study

Determining insurance eligibility is an important part of the claims billing process. If eligibility is not verified, claims may be denied and reimbursement delayed, significantly affecting the revenue cycle.​

Our client automated their eligibility verification process and realized substantial ROI as a result. Read how SphereGen helped their client reduce the length of their payment cycle by automating the insurance eligibility verification process in Meditech.

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O V E R V I E W

Claims denial is a very costly business for hospitals. Any effort which can be made to decrease the rate of denial improves patient satisfaction and supports a continuous revenue cycle. ​

Our client, a community hospital, automated the step of insurance eligibility verification to streamline their billing process and decrease the efforts involved in verifying eligibility. As a result, they were able to realize greater accuracy and significant time savings in the overall process of completing verifications, resulting in a shorter payment revenue cycle and improved cash flow.

Challenges

Eligibility verification is a process that must be undertaken several times a day as patient scheduling continuously changes. Our client had multiple people dedicated to this task to stay ahead of the demand.​

The process involved many steps including working with multiple insurance systems to confirm eligibility. For patient service requests which fail verification, claims need to be researched for errors and resubmitted within the process. ​

Processing hundreds of records every week, the workflow was tedious and time consuming. With shortages of hospital resources, staff were continuously training new personnel on a highly detailed process.

SOLUTION

To assist our client in overcoming the challenges inherent in the eligibility verification process, SphereGen created an automation which handles the submission and reporting of patient service verifications. Since most requests pass the verification process successfully, the number of claims which must be manually researched has significantly declined, saving them hundreds of hours a week. The hours gained allow the teams to process more claims each week as they can focus on resolving exception cases. This has led to a reduced payment cycle, but most importantly employee satisfaction has skyrocketed due to less tedious work and more successful results.​

RESULTS

Overall Time Saved ​

0 hours/wk
Significant time savings ​
for multiple employees​

Employee Satisfaction ​

0 %
Staff is extremely​
satisfied with new results​

Increased Productivity ​

0 %
Staff productivity greatly increased​
in other areas, due to time savings.​

THE DETAILS​

OUR APPROACH

To automate our client’s eligibility verification process, the following steps were taken:​

Automate Eligibility Submissions​

Before the automation, our client had to take many manual steps to select files and submit them for verification. Due to the volume of patient services to be verified, this method was labor intensive and slow work.​

With the new process, an automated bot can login and select all necessary menu options and files for verification submission. A schedule was set up to enable this process to run multiple times a day. The bot chooses services which have been scheduled within the next few weeks so that verifications can be checked early, leaving plenty of time to research, correct and resubmit any claims which fail verification.

Email Error Reports

Any patient services which cannot be verified, must be resubmitted directly to the insurance company to undergo a second level of confirmation for verification. To enable staff to actively work these accounts, any service request which cannot be verified is assigned an unverified status and written to a report. The reports are emailed to the appropriate teams, so that they can begin research and the resubmission process to confirm verification with the insurance company.​

In addition, if for any reason there is a problem running the process, teams are notified through email with status updates so that they can stay on top of the process timeline.​

CONCLUSION

Our client was able to realize significant benefits from this automation:​

  • Time Savings of 170 hours/week​
  • Increased Employee Satisfaction and Productivity​
  • Reduced Payment Cycle/Improved Cash Flow ​

​The large time savings allowed them to really focus on exception processing, clearing those verifications much faster. Overall, the verification process was shorter and more successful, decreasing the length of the revenue payment cycle. In addition to gaining happier employees, our client saved money and improved their cash flow.​

​SphereGen is a technology company that specializes in developing innovative solutions in healthcare to improve patient experiences and outcomes. Our customer-centric approach focuses on finding the right solution to meet the need at hand, using technologies like Intelligent Automation to improve workflow and productivity. In support of general Healthcare requirements, we also offer custom software services in Application Modernization/Support and Extended Reality.​

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