Problem Statement

Coverage and benefit details must be confirmed and entered accurately before billing, and doing this manually at volume is slow and error-prone. Medicare requires a Medicare Secondary Payer Questionnaire (MSPQ) to confirm whether it is the primary payer, but the questionnaire is often not completed with the patient at registration. Those accounts route to a customer service workqueue, roughly 1,517 a month. For each one, a team member confirms Medicare coverage is on the account, adds it from unused coverages if needed, and sends a letter or patient portal message asking the patient to call and complete the questionnaire. It is about five minutes of identical review and outreach per account, and any account not worked before the claim drops becomes a denial.

Automation Solution

This automation works the MSPQ workqueue, verifies Medicare coverage on the hospital account and adds it from unused coverages where needed, sends the patient a templated letter through the patient portal or by mail, and defers or transfers the account.