Providence Health Case Study on Eligibility Automation

This case study details the implementation of Experian's Eligibility solution at Providence Health, a prominent health system managing over 56 hospitals and 1,000 physician clinics. The challenge faced by Providence was the inefficiency in verifying payer eligibility due to high patient volumes, which resulted in increased eligibility denials and wasted resources. To address these issues, Providence sought to automate eligibility tracking, thereby streamlining workflows and reducing the time spent on manual verification processes. The implementation of the solution led to significant improvements, including a reduction in denial rates and the identification of $30 million in coverage annually. The system's Bad Plan Code Detection tool helps prevent coding errors before submission, enhancing accuracy and efficiency. Additionally, the automated work-queues and connectivity to over 900 payers have empowered staff to work more effectively. Overall, the partnership with Experian has resulted in substantial financial savings and improved patient satisfaction through better financial planning and reduced administrative burdens.