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. When real-time eligibility returns a no-coverage response, the account defaults to self-pay even though active insurance may exist under corrected or alternate plan details, so staff must rework each one through the patient workqueue. Gaps like these surface later as avoidable rework and lost revenue.

Automation Solution

This automation resolves no-coverage RTE responses on self-pay accounts via the Epic patient workqueue to convert accounts to active insurance where available.