Introduction
A large national physical therapy group was facing a backlog of more than 46,000 patient accounts requiring updated eligibility and benefits (E&B) verification. The missing E&B data was leading to increased claims denials and decreasing revenue flows. This prompted the client to set a 30-day deadline for resolution.
Challenges
The client was facing multiple roadblocks that were creating revenue leakage and operational inefficiencies:
- Massive backlog impacting revenues: 46,000+ patient accounts were pending E&B verification, with incomplete data driving claim denials and lost revenue.
- Cash flow at risk: Growing Accounts Receivable (AR) days delayed collections, worsening downstream revenue realization.
- Inconsistent data formats: Multiple clinic locations using varied formats made automation difficult and slowed processing.
- Manual process inefficiencies: Relying solely on human resources would be too costly and fail to meet the 30-day deadline.
How we made it happen
Firstsource combined intelligent automation with human expertise to streamline verification and eliminate the backlog:
- Automation at scale: Deployed an API engine and software bots to accelerate verification and reduce reliance on manual work.
- Targeting high-impact payers: Analyzed payer mix and automated ~50% of the backlog by focusing on four major payers with digital portals.
- Standardizing the data: Built a master data template as a single source of truth to power automation. Firstsource’s technology team designed the template, while the operations team defined critical fields and worked with client clinics to gather consistent information ensuring clean, standardized inputs for seamless bot performance.
- Hybrid operating model: Routed tasks intelligently across payer APIs, bot engines, and manual queues, with a dedicated team handling exceptions.
Conclusion
Within the 30-day deadline, over 46,000 backlogged tasks were cleared, and automation has since been expanded to cover 75% of all E&B verifications. Firstsource bots now seamlessly retrieve E&B data from health plan portals and update records in real time, while a dedicated team manages payers without digital support. With accurate eligibility confirmed upfront, the client now generates cleaner claims, reduced denials, and has cut AR days by 31%, securing lasting revenue impact from a solid automation foundation.