Anonymized - multi-site outpatient provider
Eligibility and claims checks before they became denials
Coverage verification and claim preparation were manual, creating avoidable denials and delayed follow-up.
48%reduction in avoidable clearinghouse work
31%fewer eligibility-related denials
The provider needed an operating layer around its existing EHR and billing systems, not a replacement for them. The project started with the points where coverage data, authorization rules, and clinical documentation lost context.
The delivered workflow checks the information available at intake, flags missing requirements before the visit, and sends only the true exceptions to the billing team. Every suggested action remains reviewable against the source record.