Customer Quote

Process discovery optimized the client's revenue cycle operations by identifying unused functionality in the EMR system, as well as identification of process automation for financial clearance and account follow-up.

Michael Duke,
Partner - Commercial Healthcare

Customer achievements.

Customer Achievements


activities captured


hours of re-work eliminated


additional use cases identified

Innovating healthcare administration with Guidehouse's AI solution to insurance eligibility challenges.

One stand-out use case involved the health system client's insurance eligibility verification process. Guidehouse observed high-volume first-pass denials and initiated a deeper investigation with Process Discovery. The analysis found that the client’s patients were mistakenly giving incorrect insurance providers, causing the health system to receive eligibility denials. These denials forced tedious employee rework and unnecessary rejections that amounted to $44 million annually.

To avoid future denials, reclaim employee time, and streamline the process, Guidehouse worked with the client to implement conversational AI. This enabled the health system to quickly contact the payer, obtain updated information, and use Intelligent Automation to update the patient's file in the system or take specific action if required. The two-pronged optimization strategy significantly reduced millions of dollars in payer denials and returned over 2,000 hours of time to the client’s employees to perform other value-added tasks.

Processes automated.

  • Deferral of accounts
  • Eligibility status updates
  • Claim corrections and resubmission
  • Physician payer credentialing confirmation
  • Prior authorization determination and submission
  • Work queue update for impact on delay/defer policy

Customer overview.

Guidehouse provides global consulting and managed services to public sector and commercial markets, with broad capabilities in management, technology, and risk consulting.

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