The Challenge
Hennepin Healthcare was experiencing rising denials, unstable authorizations, and incorrect level-of-care placement — and the damage was compounding. Large portions of payable cases were being denied due to missed authorizations, poor documentation alignment, and delayed payor communication.
Cases that should have been inpatient were entering the system at the wrong status. Documentation didn't reflect the clinical picture accurately enough to withstand payor scrutiny. And when denials did come through, the appeals process was slow, incomplete, and often missed eligibility windows entirely.
The result was preventable revenue loss at every stage — from admission, through the stay, to post-discharge appeals. The systemic issues required a real-time solution, not a retrospective one.
How bServed Fixed It
bServed addressed the root causes across four concurrent workstreams — each targeting a different stage of the utilization management cycle where revenue was leaking.
Level-of-Care Decisions Corrected at the Point of Entry
- Validating medical necessity before payor review — not after
- Engaging physician advisors within minutes of admission
- Correcting misassigned patient status in real time
- Ensuring criteria alignment for every admission before documentation is submitted
Real-Time Payor Communication Replaced Delayed Workflows
- Immediate submission of clinical documentation at optimal timing
- Same-day continued stay communication — no gaps in authorization coverage
- Tight expiration tracking across all active authorizations
- Rapid clinical updates when missing information was identified
Medical Necessity Reviews Strengthened Clinical Documentation
- Aligning the clinical picture with payor criteria before submission
- Correcting gaps, timeline inaccuracies, and missing severity indicators
- Supporting providers in real time — no retrospective correction required
- Ensuring defensible, criteria-specific language for every admission
Faster and More Accurate Appeals and Retro Reviews
- Immediate categorization of denial types to triage priority
- Fast preparation of clean, complete clinical packets
- Proper alignment with payor-specific appeal requirements
- Submission within eligibility windows — no more missed deadlines
Results
"Within the first review cycle, over 85% of all recovered cash existed because bServed corrected the process — not just individual cases. Authorizations were secured reliably, denials reversed, and level-of-care errors corrected in real time."
- 40% drop in payor denials
- 85% of recovered cash driven by bServed process correction — systemic, not case-by-case
- Authorizations secured reliably across all active cases
- Level-of-care errors corrected in real time at point of entry
- Active payor communication maintained across all continued stays
- Revenue leakage stopped at every stage from admission through appeals
- Cash flow improved quickly and measurably within the first engagement cycle