Automated Retroactive Eligibility Realignment Saves $3.5M to $5M per Year
The Washington, DC Department of Behavioral Health (DC DBH) provides prevention, intervention, and treatment services and support for people with mental and/or substance use disorders, using a population health approach to optimize each individual’s ability to function within the community. A 20-year partner of InfoMC, DC DBH has used InfoMC technology to manage and administer care for mental health and substance abuse for a variety of populations.
Efficient Behavioral Health Administration
As a government agency focused on mental health and substance abuse, it’s critical for DC DBH to be responsive to what is happening in the community. The organization’s ability to react to crises as diverse as opioid usage spikes and mass shootings depends on making sure contracted providers have the tools to identify the members that need services, quickly get services authorized, and get paid for services rendered.
The Incedo platform offers a highly configurable and automated approach to managing care across interdisciplinary teams spanning medical, behavioral, and social determinants. Over the years, DC DBH has used Incedo to manage the complete authorization lifecycle for mental health services, preventing delays and ensuring right-sized care. Incedo automates the authorization process flow through intake, clinical review, medical director review, and decision notification, with automatic turnaround time tracking to support compliance. A high degree of configurability enables automated processes to be personalized according to each provider’s requirements.
Where InfoMC’s technology has really made an impact is reducing costs through automation efficiency and retroactive eligibility realignment, enabling DC DBH to stretch its limited budget and balance Medicaid federal and local funding to more effectively support the people they serve.
Automatic Retroactive Eligibility Alignment Ensures Accurate Claims Processing
Determining eligibility for services can be tricky because coverage for Medicaid benefits may date back for a full three months prior to when the Medicaid application is filed. When insurance is updated, most systems require manual intervention to work through authorizations and adjudication to ensure claims are paid from the right insurance, a process that can be inefficient and error-prone.
With Incedo’s retroactive eligibility capability, changes to a member’s insurance trigger an automated process that accurately determines which authorizations and/or claims are impacted—no manual intervention required. Authorizations and claims are relinked to the appropriate funding stream, automatically initiating the readjudication of claims and reprocessing of authorizations and payments. Any overpayments are automatically tracked until the appropriate funding is recouped.
Incedo Drives Efficiency and Cost Savings
Incedo’s eligibility realignment capability has consistently saved DC DBH $3.5 to 5 million per year—a large percentage of its $28 to $30M budget.
But the savings doesn’t end there—Incedo’s automation significantly improves efficiency, enabling DC DBH to accomplish the work at less than 20% the cost of the alternative fiscal intermediary conduits it has considered.
“InfoMC’s Incedo solution is affordable, and has saved us a ton of money not just because it can readjudicate claims, but the high degree of automation supports timely processing and enables us to manage the process with a very skeletal crew,” said Barry. “Our small-budget group is doing things that would cost you significantly more to get them done another way. Plus, our success with reducing costs by retroactively realigning claims make it easy to ask the District for funding because they see the good work that is happening here.”
Partnership for the Long Term
In its 20 years of partnership, DC DBH and InfoMC have seen a lot of change. As the healthcare industry has evolved, the two companies have continued to partner to drive improvements the processes and technology that help make DC DBH successful.