Enhancing Patient Referral Intake with Early Insurance Eligibility Verification
Project Insight
Streamline Patient Intake with Automated Insurance Eligibility Checks
In the process of patient intake following a referral, quick decisions about patient acceptance are crucial due to time sensitivity. Traditionally, after data entry into the EHR system HomeCare HomeBase, insurance eligibility is checked. If the patient is found ineligible, it results in a non-admit, wasting prior efforts and distorting referral intake statistics, causing confusion for senior management. Our task was to streamline this process by proposing a strategy to perform insurance eligibility checks earlier, automating this step at the decision-making point.
Solution Implementation
Our solution involved collaborating with a well-known clearinghouse and utilizing their APIs to integrate insurance eligibility checks early in the referral process:
Early Eligibility Checks: As discrete information was collected, insurance eligibility was checked electronically at the point of referral decision-making.
Automated Data Entry: After eligibility confirmation, data was entered into the EHR system, ensuring only eligible patients were processed further.
Intelligent Alerts: The system included intelligence to assess when additional human validation was needed and alerted relevant staff in real-time based on the context of the referral.
Results
The implementation of this strategy led to significant improvements:
Efficiency and Accuracy: The early eligibility checks reduced instances of non-admit due to ineligibility, streamlining the intake process and saving time and resources.
Improved Reporting: The process provided cleaner data entry into the EHR and improved reporting accuracy for management, reducing potential confusion caused by non-admit statistics.
Scalability: The automated system increased scalability, allowing the lean team to manage multiple priorities more effectively.
Reduced Manual Verification: Automated eligibility checks minimized the need for manual verification through different portals or phone calls, enhancing the efficiency of the team.
Domain & Technology
- Microsoft Power Automate
- Azure SQL
- Azure BLOB Storage
- OpenAI’s GPT
- Clearinghouse APIs
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