Case Study: Providence Health finds $30M in coverage and reduces denials with Experian Eligibility

How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks

Providence Health, a 56-hospital system with more than 1,000 clinics and about 28 million patient interactions annually, faced slow, manual payer eligibility checks that forced staff to leave Epic to verify coverage and contributed to rising eligibility denials. As Epic’s payer plan table expanded, the organization needed a way to consolidate plan, contract and reimbursement data and automate eligibility tracking to reduce rework and inefficiency.

Implementing Experian’s Eligibility solution—featuring Bad Plan Code Detection, 1:1 plan mapping into Epic, connections to 900+ payers (with 300+ backups), and automated work-queues and alerts—automated verification and corrected coding errors before submission. The result: reduced denial rates (saving $18M in five months), an average of $30M in coverage identified annually, lower staff workload, improved reimbursement accuracy and better patient financial clarity.

Providence Health

Emily Brown

Director of Operation Excellence