1
Phase 1 — Eligibility & Registration (Months 1-3)
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Audit current eligibility verification process and document error rates
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Select and connect automated eligibility verification platform to EHR
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Implement batch eligibility checks 24-48 hours before scheduled appointments
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Deploy real-time demographic validation against payer databases
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Establish baseline KPIs: denial rate, days in A/R, cost-to-collect
2
Phase 2 — Claims Scrubbing & Submission (Months 4-6)
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Map payer-specific billing rules for your top 5 payers by volume
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Deploy automated claim scrubbing with CCI edit and LCD/NCD checks
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Implement electronic claim submission with real-time status tracking
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Set up first-pass acceptance rate monitoring (target: 95%+)
3
Phase 3 — Denial Management & Analytics (Months 7-12)
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Implement automated denial categorization by root cause
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Deploy auto-generated appeal letters with supporting documentation
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Build real-time analytics dashboard (days in A/R, denial rate by payer, cost-to-collect)
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Establish weekly denial review process with billing leadership
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Set up automated reporting to track improvement trends
4
Phase 4 — Optimization & Scaling
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Review and optimize automation rules based on 6+ months of data
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Expand automation to additional payers and service lines
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Implement predictive analytics for denial risk scoring
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Evaluate AI-powered coding review and CDI tools
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Document ROI and prepare expansion business case