The Challenge
Eligibility and benefits verification backlog hurting downstream revenue realization
Our client, 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. Time to correction of the situation was critical. The group gave Firstsource a deadline of 30 days in which to clear the backlog.
The Solution
Combining intelligent automation and human expertise to streamline E&B verification
The Firstsource team quickly recognized that deploying a human taskforce to tackle the outstanding E&B work would not be cost effective. Our application programming interface (API) engine and software bots could automate the process much more quickly and at lower cost.
Delivering those outcomes required us to ensure our automation implementation process was efficient. That meant identifying which of our client’s payers could support an automated E&B process. Drawing on our extensive work with payers across the country, we quickly analyzed our client’s payer mix and learned that about 50% of its outstanding E&B work was with four payers. Each of these had existing digital portals that our software bots could access, making each an excellent candidate for automation.
Mastering the data
Our client had multiple locations across the U.S., and each used its own data format. Bots work best with standardized data formats. Creating a master data template as a single source of truth to ensure the bots were efficient was an urgent task.
Firstsource’s technology team collaborated closely with our client’s team to create the template. Our operations team quickly identified the most important data to include on the template. Then we worked with our client to gather that information from its clinics. Once this time-intense and critical task was complete, we could seamlessly feed that data into the Firstsource platform and which segregates the data to various work queues including Payer APIs, bot engine and manual work queues.
The Results
Clearing a backlog in record time
Our bots retrieve E&B data from the different health plan portals and seamlessly update our client’s records in real time. A dedicated Firstsource team manages verification with payers that don’t support digital portals and automation.
With our bots and operations team, the 46,000-plus backlogged E&B tasks were verified in time to meet our client’s 30-day deadline. With the master data template as a firm foundation, we’ve expanded the bot-based automation to two more of our client’s major payers. Now 75% of its E&B verifications are fully automated.
Upstream work makes powerful downstream revenue impact
With accurate eligibility and benefits confirmed before patients begin treatment, our client now generates cleaner claims. Its denial rate and cost to collect have both dropped, while revenues have increased. A/R days outstanding have been reduced 31%.
Building a solid data foundation for automation has enabled our client to receive excellent returns on its automation investment, one that will continue to net benefits as its additional payers expand their digital capabilities.