US Eye Claim Automation Case Study

This case study focuses on US Eye, a multi-specialty eye care practice, and their implementation of the NextGen Charge Review Rules Engine to streamline their claim processes. US Eye faced challenges with a manual, four-step claim production process that consumed significant time and resources, requiring 22 charge posters to work an average of 17 hours daily. The complexity of training new staff on these processes further exacerbated operational inefficiencies. The NextGen solution enabled automation of these manual processes, serving as a centralized knowledge repository for best practices in coding and billing. As a result, US Eye was able to process 94% of their charge volume through automated rules, with 67% of issues corrected automatically. This transformation reduced denials and improved the overall efficiency of their revenue cycle, leading to more timely payments and enhanced operational outcomes across the organization.