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Streamlining Payer Approvals
Furthermore, by utilizing the GenAI solution, Beacon Health’s payers are provided with only the most essential patient information, leading to quicker approvals. Heather shared that they are now receiving approvals from three national payers in just two days compared to the previous wait time of four to five days. This significant increase in approval speed has been transformative for Heather’s team and their payer partners as care decisions are accelerated and follow-ups are reduced.
The benefits extend beyond the front-end process. With approvals received more quickly due to the consistent and concise initial review summaries generated by GenAI, Beacon Health and their payers require less additional work and back-and-forth communication to obtain approvals after the care is provided. Additionally, there are fewer bill holds due to the clearer, payer-ready initial review documentation. The GenAI solution has resulted in significantly improved throughput across the revenue cycle, from documentation to reimbursement.
Heather further explains, “With GenAI, the administrative work is significantly reduced once the patient is discharged. We can immediately send the bill out, confident that the care provided was already approved by the payer. Our team no longer needs to do additional work to ensure approval, allowing us to get paid for services in a much more timely manner.”
Empowering Beacon Health’s Care Delivery Mission
With such exemplary results achieved in only four months, Heather is eager to explore the additional benefits her team can experience by further leveraging Xsolis’ GenAI solution. Aligned with Beacon Health’s overarching mission to deliver exceptional care to the right patients in the right care settings at the right time, this AI-powered offering has empowered the Utilization Review and Case Management Team to concentrate on high-value clinical activities instead of being encumbered by administrative tasks. By streamlining the review process and ensuring consistent, comprehensive documentation, GenAI has enabled Beacon Health to enhance utilization review, improve clinical decision-making, and optimize resource utilization across the health system.
