Service line 01 - Insurance follow-up

Insurance Follow-Up Optimization

No-response follow-up and claim status. Not denials.

Most follow-up operations work static aged lists: touch the claim at day 30, again at day 45, regardless of what the payer actually does. This engagement retimes human no-response follow-up to payer behavior first, then adds 276/277 claim status automation so the system asks the payer before a person has to. Done in that order, claim status enhances a working operation. Done in reverse, it adds nothing.

Denial management is also a form of insurance follow-up. It is a different operating model with different teams and is not part of this line.

What we deliver

PB

Redesigned follow-up workqueues segmented by next action: No Response, Claim Status, Payer Rejection
CER rules and follow-up profile automations for dynamic claim status timing
Batch jobs producing 276 requests and ingesting 277 responses

HB

Redesigned account workqueues on the Springbrook framework
Batch WQs and Batch WQ Rules for claim selection and timing
Batch jobs and AIP configuration for file handling

Both

Payer build for claim status
Secure directories and transfer automations
Timely-filing safeguards
Weekly live training
Full build documentation and plain-English user guides
Optional per-payer rollout

How the engagement runs

The technical core doesn't change between clients. How the work is divided does.

Discovery begins with an operational audit of every team that touches follow-up and the duties each holds. The workqueue structure is built to that division of work, not to a template. This is also where the organization spends its political capital: the sponsor who owns team duties must be committed before build starts, not discovered during it.

Discovery

3 wks

Build

6 wks

Test

3 wks

Go-live support

6 wks

What we measure

Technical outcomes, at baseline and 90 days after go-live.

Time to first statusFrom claim submission to first payer status response.

Touches per claimManual touches before a claim reaches resolution.

Automated shareNo-response claims resolved by automated status versus manual follow-up.

Pricing

ServiceFixed fee

Insurance Follow-Up Optimization - PB

$140,000

Insurance Follow-Up Optimization - HB

$140,000

Both in one contract

$259,000

Each fee covers one billing system, one service area, one operational owner. PB and HB are separate services; the second service in a contract is 15% off.

Modifiers

Two or more services in one contract: 15% off the second, 20% off the third and each additional, applied to the lower-priced services
Each additional service area, same operational owner: +15%
Each additional operational owner: +30%
Payers beyond five, where payer count drives build: flat per-payer add

Assumptions

One billing system, one service area, one operational owner per fee
One client analyst participates 1-2 hours per week for knowledge transfer; client resources do not perform build or testing
Production and a recent-clone environment available for the duration
Current configuration, test accounts, representative files, and SME access provided within 10 business days of start
Any clearing-vendor engagement required by scope is complete before start
Springbrook has AIP access, or the client performs AIP work
The client's follow-up sponsor has authority over team duties

Warranty

One-year warranty on all in-scope deliverables, covering configuration degradation from Epic upgrades or defects within the original scope. Full build documentation, plain-English user guides, and recorded training delivered at go-live.

Book a scoping call

Scoping starts with the operational audit. The fixed fee is firm once it's done.