[Case Study] Transforming The Eligibility Verification Process of Our Texas-Based Free-Standing ER Client.

Seamlessly managing verifications for a massive patient surge during the COVID-19 Pandemic.

The COVID pandemic led to a massive, sudden upsurge in the number of patients visiting Texas-based ER. The practice was not prepared for handling the sudden change and fell short of the time and resources needed to verify patients’ eligibility and benefits.

Lack of adequate resources for insurance verification led to a decrease in their first pass rate. In many instances, the client staff missed collecting the patient out-of-pocket expenses upfront, badly affecting the practice’s cash flow. While the staff was working 24X7, the long hold time over the phone drastically affected their efficiency and bottom line.

Texas ER

Complexities arising out of the high-volume patient surge during the pandemic made our client look for an automated eligibility verification solution. The practice wanted to eliminate the long hold of phone calls with an insurance representative, going through multiple web portals to verify benefits and manual errors related to billing.

The client during these challenging times trusted eClaimStatus with a scalable insurance eligibility verification automation.

Situation before automating insurance eligibility verification

The client faced numerous challenges with manual insurance eligibility verification, which included:

  • Challenges with finding and training adequate resources
  • Keeping a track of, and following insurance specific guidelines
  • Long hold time during their eligibility verification over the phone
  • Manual keying errors while capturing eligibility and Benefits into the billing system. Errors were leading to claim denials, hence revenue leakages.
  • Challenges with switching across multiple insurance portals
  • Staff was overworked and found it tedious to remember different insurance portal login credentials
  • The staff was connecting with insurance representatives during their business hours only, leading to massive backlogs and delays.

Solutions:

eClaimStatus deployed a simple yet effective automated solution that helped eliminate all the challenges faced by our clients using a manual verification process. The salient features of eClaimStatus solution include:

  • Multi-Payer connection under one roof
  • 24/7 Automated Real-Time Insurance Verification that ensures a 100% accurate information around eligibility and benefits
  • Algorithm-based identification of exceptions, made the process watertight, eliminating chances of errors or misses.
  • Insurance verification in large volumes possible. The manual process was time-consuming since each record must be checked one after the other. The smart automated solution by eClaimStatus ensured checking of thousand of records in parallel, just by uploading the data from the scheduler. Checking multiple records in simultaneously lead to saving significant time and effort.
  • Unlimited Users simultaneously, making working in parallel possible.

The solution did not necessitate signing a long-term contract and got the client staff to speed instantly.

Results: 

With this algorithm-based automated Eligibility Verification, our client attained a sustainable robust process for insurance eligibility verification process. The client reaped significant long term benefits of:

  1. Improved hassle-free productivity from 40 patients to over 100 patients per day
  2. Reduced costs of insurance verification by 65%
  3. Improved quality from 91% to 100% through eClaimStatus automated solution
  4. Decreased coverage denial % by 1.24%

Are you looking to improve your Insurance Verification process? Contact us at 310-294-9242 or e-mail to sales@eclaimStatus.com. For a free trial, sign up here 

 


Leave your insurance eligibility verification to eClaimStatus. Get started with your 15-day free trial, call us at 310-294-9242 or write to us sales@eclaimstatus.com

eClaim Status

eClaimStatus provides simple, practical, efficient and cost effective real time Medical Insurance Eligibility Verification system and Claim Status solutions that power value added healthcare environments.