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Reduced denials and eligibility issues with IKS EVE

Pulished on: April 24, 2024

Denials Management, Denials Prevention & Management, Patient Access, Patient Access & Engagement, Revenue Cycle Management

Client profile:

A physician-led, multi-specialty medical group providing healthcare to the southeastern region of the United States. They have more than 120 healthcare professionals serving patients across 33 locations. They are on the cutting edge of the healthcare industry with a full spectrum of both preventive and specialized medical care.

Challenge:

High number of denials rooted in patient access and eligibility verification (e.g. insurance coverage and registration integrity).
Low clearinghouse transaction transaction success rates due to demographic and eligibility-based criteria issues.

Approach:

Deployed IKS EVE with autonomous Eligibility / Benefits Verification (EV/BV), to map benefits to planned services
Longitudinal Patient Profiler feature of IKS EVE ensured registration integrity by detecting and correcting mismatched or missing data in the registration feed to avoid denials
EV/BV processed for all scheduled visits and liability estimation for specific groups from first quarter
Prior Authorization conducted with payor knowledge base for specific visits when applicable, from second quarter onwards

Results:

Weekly and monthly reports demonstrated continuous ROI through substantial reduction in front-end originated denials
Delivered registration integrity, EV/BV, and eligibility estimation value
Strong denial reduction trend from $1M to $431K from Q1 to Q3 (March – Sept. 2023 data)

To learn more about IKS Patient Access solutions, contact us today at info@ikshealth.com.