The new year is a time of hope and renewal, of setting goals and refocusing on the big picture. But it is also a time of uncertainty when it comes to health insurance; with the new year comes changes in health insurance coverage, cost share, and authorization requirements. This annual cycle creates uncertainty for patients about the vital medications they depend on, and adds to the workload of providers and their staff as they must reverify insurance plan updates for their patients.

All this reverification is time-consuming and, frankly, grueling administrative work, but it’s necessary. If reverification is done inaccurately, there are real consequences to patients that can impact treatment options, delay care, or deliver unwelcome cost surprises. 

It doesn’t have to be this way, but making reverification in January and February less painful means coming to terms with what’s working and what isn’t — and learning how healthcare automation can help you gear up for the “blizzard season” in healthcare.

So many phone calls eating up so much staff time 

Benefit verification may seem like a minor but manageable task, or at worst, a necessary evil for any medical practice. But that doesn’t quite capture the magnitude of the problem in terms of cost, inefficiency, and quality.

According to the 2022 CAQH Index:

  • 28% was the increase in medical administrative transactions in 2022 vs. 2021
  • $25 billion could be saved if providers and payors transition to fully electronic transactions
  • 14 minutes can be shaved off the estimated average phone call time with electronic/automated verification 

The reality is that phone calls are still a primary means of verifying benefits, especially for specialty medications, procedures, and diagnostic testing. Payors and providers have traditionally managed the surge in reverification calls by using thousands of seasonal personnel that they’ve recruited and trained in the fall to make the necessary phone calls in January and February.

Healthcare automation increases scalability, standardization and accuracy 

Your staff has better things to do than chase reverifications and sit on hold with a payor. You know you can’t avoid or wish away reverification, but you can prevent your staff from getting bogged down with this 10x surge in administrative tasks by incorporating strategic healthcare automation. 

An AI-based approach can make a huge impact. When working with a company like Infinitus, which offers an AI-powered digital assistant, there’s no need to hire seasonal staff or work with a call center or business process organization located far, far away from the actual provider or payor. The Infinitus AI-based digital assistant can handle the entire reverification process with payors, from initiating phone calls, navigating the payor IVR, sitting on hold (which is an even bigger time drain for your staff in January), and conversing with the payor agent to capture reverification details.  

What does this mean for you and the patients you support? 

  • Having the Infinitus AI digital assistant handling your reverification phone calls gives you flexible scalability to support fluctuating patient demand
  • The Infinitus AI digital assistant learns from every interaction with payors, creating a knowledge base of what correct benefits by plan by medication should be, and can push back on payor agents when the payor agent provides incorrect or inconsistent information. Having completed over a million calls to payors, the Infinitus AI-powered digital assistant knows what good benefits are.

Let’s face it, payor agents are human, have good days and bad days, and have to jump between multiple applications and even PDFs to provide information. In fact, we estimate that payors provide inaccurate information 15% of the time, and humans speaking with the payors rarely catch it. That means a lot of rechecking, recalling, and revising, creating frustration for providers and patients alike.   

In contrast, data gathered by an Infinitus AI-powered digital assistant  can be analyzed, and anomalies quickly identified and corrected. Austin Cheng, CEO of Gramercy Surgery Center, succinctly summed up this unique advantage: “While human labor can learn and improve, it’s not as systematic and consistent as technology. Infinitus consistently delivers accurate results, allowing us to focus on providing excellent patient care.” Cheng believes that Infinitus gives his surgery center a significant advantage over competitors that use offshore teams or outsourced benefit verification.

Ready to free your teams from the bitter cold of the annual reverification Blizzard and let them focus on what they do best? 

Contact us to learn more about how Infinitus can help.