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Patient Access

Providers’ fiscal well-being, like physical health, is all about taking proactive measures.

The more healthcare providers know about a patient’s coverage and benefits in advance of care delivery, the more likely full and prompt reimbursement is realized. This is particularly true in an era of increased patient responsibility.

SCALE^®Patient Access is an integrated RCM technology solution comprised of:

Eligibility Verification
Coverage Detection
Patient Identity
Financial Clearance
Revenue Recovery
HRSA Registration
Prior Authorization
Notice of Admission

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Eligibility Verification

Verify patient coverage and benefits in real-time with greater flexibility and accuracy.

A high-quality, timely eligibility request and response at the time of registration goes a long way toward ensuring a positive patient experience. Not to mention tightening the revenue cycle by reducing A/R days and preventing denials on the backend. SCALE Eligibility may be integrated with patient registration systems or accessed independently via a web-based interface.

Validate patient coverage and benefit details, including PCP & Specialist co-pay, deductible, covered services, inpatient days, and more
Access all available data in a standardized format, inclusive of chaining and primacy
Resolve accounts with incomplete or inaccurate data on file
Identify Medicare and Medicaid replacement plans

Coverage Detection

Automate the identification of existing coverage for self-pay, bad debt or charity accounts, and additional coverage for patients enrolled with multiple insurance plans.

SCALE Coverage Detection automatically identifies existing coverage for self-pay, bad debt or charity accounts, and additional coverage for patients enrolled with multiple insurance plans—in real-time. Even with minimal data being supplied, we can identify coverage for uncompensated care and the associated in-network or out-of-network benefits.

Improve efficiency by automating burdensome tasks
Coverage Detection runs automatically when patient eligibility cannot be verified
Results are presented in real-time and automatically update the patient health record
Discover insurance benefits for self-pay patients at the time of registration

Patient Identity

Automatically identify and correct outdated or inaccurate patient demographics and contact information.

We use a rigorous verification process across patient demographic and insurance data elements to determine the patient’s identity and active coverage, allowing you to auto-update insurance coverage and demographic data with confidence.

99.2% data confidence score
Verify name, address, email, phone number and phone type
Corroborate with DOB and SSN attributes, even if not provided
Custom confidence scoring is used to determine which accounts should auto-post and which should be reviewed

Revenue Recovery

The average hospital writes off 8% of reimbursable claims due to invalid data--we can fix that.

We provide an alternative to write-offs and collections by deploying highly trained healthcare specialists with AI and our intelligent insurance coverage and demographic neural network, to recover your money in the most efficient, user friendly manner.

Identify uninsured accounts for 501C-3 and 501R purposes
Identify HRSA reimbursement opportunities
Replace inaccurate data with active insurance coverage and demographic information
Discover missed DSH days

HRSA Registration

Automate HRSA COVID-19 Uninsured Patient Registration

We identify all COVID-19 patients that are self-pay, no insurance accounts, and register them electronically on the UnitedHealth Group HRSA COVID-19 Uninsured portal. SCALE securely retrieves the patient’s temporary ID number and updates your EHR, allowing claims to route to the appropriate destination and avoid being denied.

Automatically register uninsured patients
Retrieve the patient’s temporary ID required for billing
Update your EHR with accurate data
Submit claims with confidence