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4 ways First Day Homecare optimizes secondary billing processes with AlayaCare’s Coordination of Benefits

First Day Homecare - Coordination of benefits_ Reducing redundancy and enhancing billing accuracy

Pediatric private duty nursing agency First Day Homecare faced significant hurdles and inefficiencies in billing secondary insurance claims and multiple payors. The lack of a streamlined solution led to time-consuming and inefficient workarounds and the need to process multiple claims manually for each visit. This process resulted in multiple errors and delays. First Day Homecare was determined to find a solution to simplify its process for secondary billing to improve operations and continue to grow its franchise.

First Day Homecare found the solution to their manual secondary billing problem when they adopted the AlayaCare platform and Coordination of Benefits feature.

AlayaCare’s Coordination of Benefits modernizes the billing process for secondary insurance claims and provides a more efficient and accurate alternative to traditional manual adjustments in clearinghouses.

“We were thrilled when we first learned about it, and it has completely lived up to all our expectations. For us, this stands out as one of AlayaCare’s most impactful capabilities, and personally, it’s one of the [features] I’ve been most excited about!”
Harvey Mathews, Co-Founder of First Day Homecare.

Hear from First Day Homecare how AlayaCare’s Coordination of Benefits improves their business:

4 benefits First Day Homecare gained by using AlayaCare’s Coordination of Benefits

1. Simplified billing of secondary insurances and audit trail transparency

With inefficient manual claims processing, agencies face a high risk of inaccuracies or discrepancies in accounts receivable which can significantly affect an organization’s revenue cycle management. This was one of the major challenges First Day Homecare experienced.

With Coordination of Benefits, billing secondary insurances is far more simplified as agencies are equipped to handle the billing of secondary insurances much more effectively by bypassing the manual claim adjustment process in the clearinghouse.

“The coordination of benefits capability is a million times better. The manual work we used to do before was overwhelming and practically impossible to manage.”
Harvey Mathews, Co-Founder of First Day Homecare.

This capability also ensures a seamless and transparent process by maintaining a thorough audit trail at every step and providing expanded accountability and ease in tracking. With a full audit trail to track revenue for each payor, agencies like First Day Homecare can have:

Enhanced financial transparency: A comprehensive view of revenue streams from different payors, enabling better financial decision-making and revenue management.
Accountability and compliance: Adherence to regulatory standards by maintaining a detailed record of all financial transactions and interactions with each payor.
Error detection and resolution: Quickly identifying discrepancies in revenue tracking, allowing for prompt investigation and rectification of any issues.

2. Reduced hours of administrative workload

As First Day mentioned, their manual work for secondary billing was overwhelming and extremely challenging to manage. “Before, we had to manually sift through months of schedules to adjust billing, which was time-consuming and led to duplicate entries in our account receivables,” said Danielle Clemons, Administrator at First Day Homecare.

Coordination of Benefits simplifies their visit scheduling and adjustments and eliminates hours of administrative work, significantly cutting down on the agency’s billing workload. By eliminating these manual tasks, First Day Homecare can free up valuable time to better utilize its human resources and enhance operational efficiency.

Coordination of Benefits does this by automatically redirecting claims to the secondary payor once a lifetime cap is reached, ensuring seamless continuation of billing without manual intervention.

“I believe the Coordination of Benefits feature will greatly benefit everyone at First Day. It will clear up the confusion regarding billing primary payors and automate the transfer to secondary ones. It makes my life easier and the scheduling side easier as well.”
Danielle Clemons, Administrator at First Day Homecare.

3. Enhanced billing accuracy

Other challenges First Day Homecare faced with manual secondary billing were duplicate data entry, increased claim errors, leading to many rejections.

With Coordination of Benefits, First Day reduced their risk of denials and eliminated duplicate entries in the clearinghouse by automatically capturing and transmitting 835 and 837 occurrence and reason codes to secondary insurances.

“Thanks to Coordination of Benefits, I’m excited about this year’s revenue reporting. It will be accurate from the beginning, alleviating any concerns about double counting visits.”
Harvey Mathews, Co-Founder of First Day Homecare.

Additionally, Coordination of Benefits enables the production of accounts receivables for each payor within a claim. Through this, agencies like First Day can have:

Individual payor management: Enables tailored financial tracking and management for each payor, leading to more efficient accounts receivable processes.
Customized reporting: Offers the ability to generate detailed reports for each payor, aiding in analyzing trends and making informed decisions specific to each payor.
Improved cash flow: Streamlines the process of tracking and collecting receivables from each payor, enhancing the organization’s cash flow and financial health.

Therefore, creating efficient billing and operations with reduced risk of errors enhances First Day’s billing accuracy.

4. Faster claim processing and reimbursement

Previously, First Day’s manual processes led to delays in claims submissions and reimbursement, which negatively impacted their cash flow and overall financial health. With Coordination of Benefits, First Day optimized their disposition workflow, allowing immediate billing to secondary payors with a single denial entry. This expedited reimbursements and reduced claim rejections as Coordination of Benefits automatically checks for errors, eliminates manual tasks, and allows agencies to submit multiple claims simultaneously with one click.

“We’ve eliminated the need to backtrack months to adjust visits, which saves us significant time and effort,“ said Mathews.

Coordination of Benefits directs items from one claim to more than one payor within the same change payor workflow. With this, agencies like First Day have:

Multi-payor flexibility: Allows for the distribution of claim items to multiple payors, accommodating complex payment scenarios and ensuring comprehensive claim coverage.
Workflow efficiency: Simplifies the claims processing workflow by handling multiple payors within a single claim, reducing administrative burden and enhancing operational efficiency.
Reduced payment delays: Minimizes the risk of payment delays by efficiently managing and directing claim items to the appropriate payors, ensuring timely.

“Everything has been going smoothly. We successfully mapped the insurance provider to our clearinghouse, and the claims are processed automatically without any manual interventions.”
Harvey Mathews, Co-Founder of First Day Homecare.

Before adopting AlayaCare’s Coordination of Benefits functionality, First Day Homecare faced significant hurdles, manual processes, errors, delays, and other inefficiencies when billing secondary insurances.

Now, with AlayaCare’s Coordination of Benefits solution in the AlayaCare cloud platform, First Day Homecare can simplify their billing of multiple payors, have better audit trail transparency, reduce hours of administrative workload, enhance billing accuracy, and gain faster claim processing and reimbursement.

The immense benefits of Coordination of Benefits greatly optimize their operations and improve their revenue cycle management.