“We’re actually proud of Experian. It takes away duplication of efforts and permits us to see the larger image. The eligibility answer works effectively for our staff and sufferers.”
—Emily Brown, Director of Operation Excellence at Windfall Well being
Problem
Windfall Well being is a number one well being system comprising of 56 hospitals and over 1,000 doctor clinics. With an annual affected person quantity of over 28 million, Windfall strives to prioritize the well-being of their sufferers by offering handy, accessible, and reasonably priced medical companies.
Due to excessive affected person volumes, they confronted points with gradual payer eligibility processes and elevated eligibility denials, which meant their workers spent lots of invaluable time verifying eligibility manually.
Moreover, as Epic’s payer plan desk expanded, Windfall Well being wanted an environment friendly solution to consolidate and align the information pertaining to insurance coverage, contracts, and reimbursement particulars. To be able to streamline the method and maintain their workers inside the system, Windfall Well being sought to automate eligibility monitoring.
Answer
Windfall Well being applied Eligibility Verification and leveraged the Unhealthy Plan Code Detection device, which identifies coding errors earlier than they’re submitted to payers. With this answer, the system instantly alerts customers when an incorrect plan code is flagged, permitting customers to repair any points shortly and keep away from pricey declare rework. Moreover, integration with Epic facilitated seamless 1:1 plan mapping, and automatic the creation of recent protection information in Epic primarily based on responses obtained. This streamlined the method, eliminating guesswork for employees and making certain correct plan choice.
Emily Brown, Director of Operation Excellence says, “Our seek for an answer that seamlessly integrates with Epic led us to decide on Experian Well being as our most popular vendor, given their confirmed monitor file of working with Epic.”
By working with Experian Well being, Windfall has uninterrupted service and connections to over 900 payers, with backup connectivity to 300 extra payers. Windfall workers can make the most of automated work queues fueled by response information and customized alerts, which permits them to work extra effectively.
End result
Because of Eligibility Verification, Windfall Well being achieved the next outcomes:
Discovered a mean of $30 million in protection yearly
Saved $18 million attributable to decreased denial charges inside 5 months
By automating eligibility checks for top affected person volumes, Windfall Well being boosted affected person satisfaction whereas considerably lowering workers workload. Partnering with Experian Well being allowed them to determine an elevated quantity of lively eligibility, making certain correct reimbursement and avoiding declare denials. Automation additionally eradicated time-consuming duties, permitting workers to deal with offering higher affected person care.
“Checking if my insurance coverage was accepted was a quick and pleasant course of. The workers even helped make clear which insurance coverage was the correct one for me since I had a number of playing cards.”
– Windfall Well being Affected person
Study extra about how Eligibility Verification helps healthcare organizations entry real-time insurance coverage protection information, enhance reimbursement charges and keep away from declare denials.
