Bottlenecks in eligibility mean bottlenecks in care.
According to Medical Economics, the number of providers claiming that denials are increasing jumped nearly 54% in just two years. It’s clear that claims are growing, and hospitals need to address them. One way to do this is to improve data accuracy and workflow automation.
Challenge
Negative patient experiences and revenue loss caused by manual eligibility verification
Solution
Salesforce Health Cloud
Results
Reduced denials, higher patient satisfaction, and increased revenue
The Problem
Hospitals struggle with verifying patient eligibility for various reasons. First, the process is highly manual. Administrative staff must either access multiple payer portals or spend considerable time on the phone to confirm eligibility. These processes result in back-and-forth communications that often cause human error and delays in care.
Bad data is another root cause.
Hospitals often have outdated information on file, or patients make mistakes when they provide information. Manual data entry can cause even more issues, significantly increasing the risk of denied claims.
Bad data and manual processes create a perfect storm that causes various issues, including high denial rates and patient dissatisfaction. High denial rates create even more administrative burdens, including reworked claims, appeals, and write-offs for unpaid services. The impact? Cash flow disruption and the revenue cycle.
Denials negatively impact patient experience as well. Manual processes lead to unexpected bills, delayed payments, and overall dissatisfaction.
The Solution
Manual eligibility verification is time-intensive and creates headaches for staff. Salesforce Health Cloud removes these manual processes with consistent workflows, payer integration, and AI-powered insights.
Improving the process all starts with data.
Health Cloud pulls information from your entire tech stack, including EHRs, ERPs, marketing platforms, and clinical systems. Integration creates a complete, up-to-date patient profile, from demographics to clinical history to benefits details. There is no more system-hopping; there is just one reliable source of truth.
With accurate data in place, automation can take over. Health Cloud connects to clearinghouses and verification services like Quadax and Availity. Thanks to a workflow engine, eligibility checks can be automated during registrations, scheduling, and treatments. That means your staff can skip the manual data entry and payer phone calls. What about tracking? Health Cloud’s workflows monitor verification statuses for you, cutting out manual follow-ups. With Einstein AI in the mix, you can identify patterns from past denials and flag risky claims before submission. It’s smart, proactive, and designed to make your team’s life easier.
The Results
Reduced Denials
Higher Patient Satisfaction
Increased Revenue
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