The Challenge
Providence Little Company of Mary faced a breakdown that began in the Emergency Department — silently allowing missed admissions, creating denials, downgraded stays, and lost revenue despite the best efforts of its clinical teams using traditional admission steps.
Early clinical decisions were not consistently aligned with payor requirements, and they were not supported with strong enough medical necessity indicators. Authorizations were not always secured in time. This exposed the hospital to denials, downgraded stays, and lost reimbursement across multiple payor contracts — revenue that was never recovered.
Providence needed control at the exact moment clinical and financial risk originates: in the Emergency Department, before the patient is admitted, when the right decisions still determine whether a claim gets paid.
The bServed Strategy
bServed executed two concurrent deployments — a full ED Utilization Management program and a parallel Behavioral Health UM deployment — both delivered as plug-and-play solutions with minimal operational burden on existing staff.
Specialized Software
Real-time technology integrated with the EMR to surface utilization signals and drive timely action across all service lines.
Workforce Integration
Clinical and revenue cycle experts function as hospital extensions without disrupting physician workflows or requiring new system training.
Authorizations
Immediate payor notification with complete clinical packets and secured authorizations aligned with the patient's clinical presentation.
Revenue Cycle Maximization
Correct level-of-care decisions reducing downgrades, improving claims quality, and ensuring every stay is fully reimbursable.
Medical Expertise
Behavioral health specialists, physician advisors, and review nurses with clinical floor experience guiding high-acuity decisions in real time.
Real-Time Reporting
Leadership visibility into authorization status, level-of-care decisions, and financial performance from ED to discharge.
Hospital-Wide ED-Focused Control
bServed took over real-time review and authorization processes beginning in the Emergency Department, covering all hospital care levels. Physicians maintained unchanged clinical practices. Existing staff avoided new system training. The deployment was immediate and non-disruptive.
- Real-time InterQual and MCG-based admission status determination for Emergency Department patients
- Increases Emergency Department admission rate — 11% to 15% demonstrated
- Physician recommendation delivery, 24 hours a day, 7 days a week
- On-site Case Managers are freed to focus on patient throughput and capacity management
Behavioral Health Parallel Deployment
Behavioral Health was deployed simultaneously with hospital-wide UM — a complex undertaking given the unique challenges BH presents:
- Rapid patient status shifts requiring immediate documentation response
- Stricter payor expectations and more detailed documentation requirements
- Greater timing and criteria sensitivity across involuntary and voluntary holds
- Heightened risk of denial when legal status transitions are not captured in real time
- Working closely with the California Department of Mental Health to gather requirements for the inpatient TAR process
- Concurrent authorization management for the Chemical Dependency Unit, ensuring each day is approved by commercial payors while detailed clinical information is provided based on payor requirements
bServed delivered dedicated Behavioral Health utilization management concurrently, implementing real-time oversight, payor-specific documentation packets, and physician advisor involvement for complex scenarios — without delaying the hospital-wide rollout.
Results
"Within the first engagement cycle, Providence achieved a verified 10X ROI — recovering $790,000 in cash with $994,000 in additional identified opportunity. The baseline admit rate of 11.3% improved to 14.2%, a 25.8% increase driven entirely by justified clinical decisions and secured authorizations."
- Baseline admit rate improved from 11.3% to 14.2% — a 25.8% increase
- $790,000 in recovered cash from justified cases and secured authorizations
- $994,000 in additional identified revenue opportunity
- 10X verified ROI across the engagement
- Parallel Behavioral Health UM deployed without disruption, resulting in a decrease of TAR denials to under 2%
- Zero physician workflow disruption — existing staff required no new training