It’s time to transform insurance claim processing, part 2

Built to fail

Countless staff hours are lost to the antiquated and unintuitive system of insurance claim reimbursement. The deck is particularly stacked against smaller practices. With fewer resources, the burden is more profound, and the mistakes are easier to make. Denied or delayed payments hit hard. 

It’s a system that, to many practices, almost feels rigged to produce errors. Indeed, administrative errors are among the most common reasons for claims denials. Practices are desperate for help. Many healthcare providers get out of the business altogether, giving up to the claims processing time sink and all its ramifications. 

The administrative burden related to insurance claims submissions isn’t news to us, or to any provider in the sector even for a short time. That it can be a deterrent to new mental healthcare talent entering the field is equally worrisome.

Enough already

At MediSprout, we take the position that claims processing simply doesn’t have to be so clunky. Not anymore. To our minds, it’s a matter of applying smarter technology design; putting the needs of practices and patients first—in all facets of our platform.  

Here are four additional features in our integrated practice management and EHR platform that are especially effective at eliminating administrative errors that set off hair-trigger claim denials. 

Automated Eligibility Checks

Checking on a patient’s eligibility status is largely a manual task. Typically, the effort involves a time-consuming journey inside an insurance portal or perhaps a phone call to the carrier. (Hold, please.”) Skipping the task and assuming that the patient’s eligibility is an option of course, but it’s a costly gamble if the assumption fails. And it happens. 

Automated eligibility checks inside the MediSprout platform eliminate eligibility errors that cause claim denials. The system also checks coverage gaps, co-pay expectations, and prior authorization requirements. 

Imagine the time savings. Imagine the on-time payments. Imagine no surprises.  

AI-Driven Claim Scrubbing

Standard healthcare insurance claim forms require some 33 fields of data. If one is off by a single digit or letter or code, boom—denied. But what if there was an automated system that uses AI to scan for errors or for incomplete entries before the claim is submitted? 

AI-claim scrubbing from MediSprout does just that. Every detail is analyzed and flagged. From errors on visit locations to diagnosis mismatches to missing carrier details, MediSprout AI-claim scrubbing tool is trained to recognize virtually any denial pattern.  

Denial Detection + Smart Resubmission

Practices must dedicate staff time and revenue to the manual review of EOBs, code deciphering, and denied claims appeals. 

Automated claims processing from MediSprout uses AI to analyze EOBs, identify the reason for denial, and pre-fill corrected claims or appeal letters. Save hours per claim and recover lost revenue.  

Payment Reconciliation + Insights

Sometimes, therapists don’t recognize whether they are being underpaid or are not being paid at all. 

MediSprout matches payments to claims automatically. Underpayments are flagged. Up-to-date dashboards document and display what you’ve billed and what you’ve received. No more guesswork. Automated claims processing offers more insight, which gives therapists more transparency and control.  

Paving the way to a smooth care lifecycle

There may not be a bigger sore spot in healthcare technology than in the systems that drive insurance claims submissions and processing. Current platforms are not built or designed with the real needs of today’s therapists and practices. We’re flipping that mentality on its head. 

We’re focused on the pain points therapists and patients feel today, starting with the visit. Nothing happens without that first session. The care lifecycle springs from there and automated insurance claims processing will go a long way to keeping obstacles from getting in the way of the best possible care outcome.  

Ben Putland is the COO of MediSprout.