Case Study: a leading national infusion therapy provider finds $52.5M in denials and payments with Simple Fractal's payer portal automation

How we outperformed claim status teams by $52.5M

A leading national infusion therapy provider faced significant challenges in managing its high volume of healthcare claims. The manual process of checking claim statuses and retrieving Explanation of Benefits (EOB) documents across multiple payer portals was slow, error-prone, and led to millions of dollars in unidentified denials and unposted payments. To address this, they partnered with Simple Fractal for an automation solution.

Simple Fractal built a suite of customized RPA bots to automate the entire claims status-checking process across various payer portals. The solution integrated with the provider's Advanced MD system to retrieve, interpret, and post data with consistent accuracy. This resulted in the discovery of $42.4 million in missing denials and $10.2 million in unposted payments. The automation also reduced the follow-up time from 120 days to under 11 days and eliminated the need to hire 11 full-time employees, delivering a significant return on investment for the client.