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Solving the ‘employee eligibility challenge’ at scale

By
2021-10-21

Manage employee eligibility with ease

For the growing number of direct-to-employer healthcare providers—including direct primary care (DPC) and onsite/near-site groups—simply understanding which employees are eligible, which ones are enrolled, and which ones are engaged at a given point in time is, well, not so simple—especially when dealing with notoriously messy census files from larger employers and third-party administrators (TPAs).

Tricia Stanley, DNP is Director of Clinical Integration at Proactive MD. She spoke with us about the challenge of staying on top of changes to employee eligibility status as well as changes to patient details like contact information.

“Before HintOS it was difficult keeping track of membership details, eligibility, and what to charge. We had one system just to collect the payment, but the staff would have to look at a separate spreadsheet to see if the patient was eligible. It was a 12-step process just to say ‘this is what you owe today’ and collect the payment.”


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The combination of unpredictable census files and manual administrative workflows can too often result in practices not having up-to-date information when patients walk in the door. This disconnect has a negative impact not only on the patient experience but also on revenue. Stanley continued, “In our model, every client has a different contract. Before Hint, more times than not, if we couldn’t find the source of truth, we’d err on the patient's side and not charge additional fees. It happened every week across our health centers to some degree, and I suspect care was given away. It wasn’t scalable, and we were not all on the same page.”

But that’s all changed—now you can sync patient data from employer HR systems and TPAs directly into HintOS and your EHR.

Introducing Eligibility AutoSync™—only on HintOS

 

Over the past 24 months, Proactive MD and other direct-to-employer provider organizations have helped Hint’s product development team test a new tech solutions that clean up and automate the flow of eligibility and patient information from employers’ HR systems into HintOS and downstream into EHRs—including Elation, athenaClinicals, and Akute. We're calling it Eligibility AutoSync.

An easier, more cost-effective way to bring DPC to large employers
No longer will your team have to spend time manually updating patients in an employer account or trying to fix census files that arrive in different formats and with varying levels of data-completeness. With Eligibility AutoSync, HintOS automatically ingests employee census files from Third Party Administrators (TPAs) and HRIS systems — so your team can focus on what matters most—patient care. 

Freda Frid, senior product manager at Hint, led the complex product development process.

“Over the last two years, we’ve worked with a variety of practices, employers, TPAs, brokers, and HRIS administrators to automate over 100 census files and process millions of rows of patient data. From all those real-world examples and edge cases, we learned that every data exchange is unique in its complexity—and all those learnings helped us build a truly smart and sophisticated end-to-end system.”

Freda shared some interesting stats from the testing phase:

  • 17 DPC organizations tested Eligibility AutoSync
  • 170K patients across 567 employers
  • 100+ files (including multi-company files)
  • 47K manual touch points eliminated every month—saving an estimated 400-800 hours
  • Eligibility AutoSync manages 70% or more of the members for seven participants


Hint Health CEO Zak Holdsworth noted the significance of this new release for practices, patients, and the broader direct care industry.

"Ensuring a seamless flow of data from employers to clinicians is a critical step in helping our customers provide high-quality, responsive care to their members. We also believe that we’ve eliminated a significant operational barrier for practices to take their services directly to employers."


Why you'll love Eligibility AutoSync

  • Always know who’s eligible and how much they owe thanks to automatic file processing
  • Changes flow immediately into your HintOS-integrated EHR
  • Flexible & configurable settings to fit your needs
  • Easily view and track changes in HintOS
  • Get notified when files are received and processed
  • Secure & HIPAA-compliant data exchange (via SFTP)
  • Set it and (pretty much) forget it — Our dedicated service team handles setup and continuously monitors, reviews, and resolves any issues that require human intervention. (Hint Health’s standard Service Level Agreement applies.)


Pricing

Eligibility AutoSync is now available to Hint customers on our Employer and Enterprise tiers (including customers on legacy HintOS Plus and HintOS Pro plans).

Pricing is based on 1) the number of eligibility files you want to sync and 2) the number of rows in each file. You’ll pay $75 per 2,000 rows per file per month.


Getting started with Eligibility AutoSync

To learn more or get started, contact support@hint.com (current Hint customers) or sales@hint.com (if you’re not yet a customer).


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