Easterseals Central Illinois faced significant challenges in their revenue cycle management process that were impacting their ability to serve families effectively. High accounts receivable days, claim denials, and burdensome manual processes were creating bottlenecks in their operations and affecting their bottom line.

The organization struggled with several critical issues in their RCM workflow:

• Extended A/R days causing cash flow delays
• High frequency of ABA claim denials
• Manual errors in CPT codes and missing modifiers
• Complex payer-specific rules requiring time-consuming manual edits
• Resource-intensive processes pulling staff away from higher-value activities

Thoughtful AI implemented a comprehensive solution to automate and streamline primary claims processing. The implementation included:

• Custom-designed automation workflows aligned with Easterseals' specific needs
• AI-powered verification of CPT codes and modifiers
• Compliance checks for payer-specific requirements
• Seamless integration with existing systems

The results were transformative:

• Reduced A/R cycles by 35 days
• Decreased primary denials by 7%
• Cut ABA claim denials to under 2%
• Significantly reduced manual processing time
• Improved compliance with payer requirements

With automated primary claims processing, Easterseals Central Illinois has shifted their focus from managing daily operational challenges to implementing strategic improvements. This transformation has not only enhanced their financial performance but also strengthened their ability to fulfill their mission of serving families in their community.

The success of this implementation demonstrates how AI automation can help healthcare providers optimize their revenue cycle while maintaining high standards of compliance and accuracy. For Easterseals Central Illinois, this means more resources available for their core mission: providing exceptional care to those who need it most.