This success story highlights how a large health system partnered with EnableComp to overcome persistent challenges in managing Veterans Administration (VA) claims. Through intelligent automation and expert guidance, the health system streamlined its processes, significantly improving reimbursement and strengthening its financial performance.
The Challenge
A large health system in the Western United States, with over a century of service and more than $6 billion in annual patient revenue, faced significant challenges managing Veterans Administration (VA) claims.
The health system faced high denial rates, lagging reimbursements for care they delivered to veterans, and frequent write-offs.
Faced with ongoing labor shortages, the health system recognized that maintaining the specialized expertise needed to effectively process VA claims in house was impractical. The healthcare provider decided to partner with EnableComp to streamline their VA claims process and address these critical challenges.
The Solution
EnableComp conducted a comprehensive review of the organization’s hospital-based VA claims. This uncovered several key issues, including:
- Missing payer and employer information: Critical information omitted at registration resulted in submission errors and delays.
- Authorization problems: Claims were being denied due to misaligned or missing authorizations.
- Denial follow-up: Delayed follow-ups on denied claims exacerbated revenue leakage.
- Incorrect payer submissions: Some claims were routed to the wrong entities, causing processing delays.
EnableComp employed a multifaceted approach to address the health system’s challenges. Its proprietary E360 RCM™ platform — an intelligent automation solution purpose-built for the most complex areas of the revenue cycle — played a pivotal role in transforming the VA claims process.
The VA experts at EnableComp worked closely with the health system to eliminate ineffective processes and delivered specialized VA training for the provider’s registration teams to prevent issues from happening in the future.
Ensuring proper claim submission protocols and leveraging E360 RCM’s analytics and automated workflows accelerated VA claim processing and reduced errors. The partnership with EnableComp not only strengthened the health system’s financial performance but also enhanced its ability to serve veterans more effectively.
The Bottom-Line Impact
By leveraging EnableComp’s E360 RCM™ platform and expert support, the health system achieved a 46%+ annual cash uplift and secured over $6 million in additional collections for VA claims.
