Problem Statement

When a patient's Primary Care Physician (PCP) assignment doesn't match what the payer has on file, claims and referrals can misroute, so the patient needs to be prompted to update their provider information. Reviewing each mismatch and following up manually is repetitive, and an unresolved mismatch keeps causing downstream errors until it's corrected.

Automation Solution

This automation reviews PCP-mismatch flags in Epic, sends patients an InBasket message to update their provider information, rechecks the status via real-time eligibility after a set period, and escalates if the mismatch persists.