Changing Contract Requirements
Systemic processing mistakes occurred under the old contract, with changes initially flagged as errors when the new contract went into place.
FINANCIAL CARE CONTINUUM | STEP 4
What Happens When You Connect the Entire Patient Financial Experience?
For one large academic health system, a transition back in-network after a contract dispute created challenges across the patient financial journey. The team needed more than additional collection capacity. They needed a partner who could connect payer recovery, patient support, and self-pay collections while navigating changing processes and complicated patient stories along the way.
One Engagement. Three Connected Workstreams.
Insurance recovery doesn't end when a claim is resolved.
The outcome of that work can shape what happens next: what the patient owes, when they receive a statement, what they understand about their balance, and whether they are prepared to engage. That's why connecting insurance recovery and self-pay matters.
For one large academic health system in the Midwest, that connection became especially important during a transition back in-network with Anthem following a contract dispute.
The organization needed to keep claims moving, recover stagnant out-of-network A/R, support patients through the transition, and maintain operational stability as payer rules and workflows evolved.
The answer wasn't simply more resources. It was a more connected approach.
A Complex Transition Created More Than Just Claims Challenges
As the health system moved from out-of-network to in-network status, the revenue cycle had to adapt to new reimbursement rules, processes, and workflows while managing an already confusion and frustrated patient population. We identified and corrected a number of process gaps, including:
Root Cause Identification
IUDs were regularly being denied & specialty prescriptions caused billing issues that were not previously identified through adjustment codes
Process Improvements
Among other issues, we identified that refund requests were not processing correctly and one payer was consistently sending checks to the wrong P.O. Box.
The Result? More Than Recovery.
By working across insurance follow-up, patient support, and early out, Revco was able to identify gaps upstream that were affecting performance across the revenue cycle:
- Understand payer behavior: Develop deeper visibility into inconsistent payer processing and unclear reimbursement logic
- Find root causes: Identify recurring issues that weren't always visible through standard adjustment codes or existing workflows
- Reduce internal burden: Take ownership of complex, labor-intensive accounts while internal teams focused on core priorities
- Turn findings into action: Use recovery activity to identify opportunities to reduce avoidable denials, write-offs, and downstream challenges
One Patient. One Journey. One Connected Approach.
Explore the Financial Care Continuum:
One brand. One patient experience.
The care your patients need doesn't stop with their clinical experience. It extends to the financial care they receive, and it is an experience that often stays with them much longer than their episode of care.
At Revco, we aren't just the "next step," and we don't replace your financial services team. We become an extension of it. We combine revenue cycle expertise with experience patient financial advocates to resolve complexity, protect your brand, and recovery more revenue before accounts become bad debt.
If you're ready to explore a seamless financial experience, contact us today.