Providence partnered with bServed to fix the problem at its source. This required proactive clinical expertise and a fully trained real-time utilization team, not a late-cycle RCM or coding vendor. SWARM allowed bServed to stop revenue leakage before it began.
bServed used its SWARM strategy to execute two complex implementations at the same time:
- A full takeover of real-time review and authorization processes beginning in the ED and affecting all hospital levels of care.
- A parallel Behavioral Health deployment in one of the most complex and high-risk service lines.
Both were delivered as plug and play solutions with almost no operational lift from the hospital.
SWARM: The Framework Behind the Results
| Specialized Software | Real-time technology that plugs into the EMR, surfaces utilization signals, and drives timely action. Purpose-built by bServed to deliver results for hospitals. |
| Workforce Integration | Clinical and RCM experts function as an extension of the hospital, working inside existing workflows without disrupting physicians. |
| Authorizations | Immediate payor notification, complete clinical packets, and secured authorizations that match the clinical picture from the start. All supported by solid criteria sets based on MCG and InterQual as well as payor specific criteria. |
| Revenue Cycle Maximization | Correct level of care decisions, fewer downgrades, cleaner claims, and fully supported reimbursable stays. Result in consistent cashflow and perfect reimbursement. |
| Medical Expertise | Behavioral Health specialists, Physician Advisors, and review nurses with floor experience as well as strong training guiding high acuity decisions in real-time. |
Plug & Play | Teams & Tech:
Hospital Wide Control Starting in the ED
Providence didn’t need a basic support tool. It needed control over the moment when clinical and financial risk is created.
The breakdown started in the ED, where early decisions and communication with payors influence:
- Whether a patient is admitted
- Which level of care is selected
- Whether the stay will be fully reimbursed
bServed took over this real time review and authorization process. The hospital provided EMR access and reporting access. The Specialized Software and Workforce Integration handled the rest inside existing workflows.
Physicians did not change how they practice.
Nurses and case managers did not have to learn new systems.
The process ran behind the scenes yet influenced every admission and every level of care determination throughout the hospital.
Because SWARM controlled both the front-end decisions and the Secure Authorizations, the impact extended to IP, OBS, ICU, Telemetry, MedSurg, and Behavioral Health.
Performance and Reimbursement Impact
- Baseline Admit Rate: 11.3 %
- bServed Actual Admit Rate: 14.2%
- Improvement: 25.8%
- Revenue captured: $295,000
These are not just more admissions. They are justified admissions where bServed secured 100% of the Authorizations.
SWARM ensured that:
- The clinical story matched the level of care
- Secure Authorizations were obtained in time
- Payors received clear, complete clinical packets
That combination is what made these admissions fully reimbursable and why the performance gain is defensible.
bServed also identified 141 additional opportunities that would bring Providence to a 21.4% admit rate and unlock an additional $994,000 in revenue.
The verified return was a 10X ROI, driven primarily by justified cases and secured authorizations, not loose admission behavior.
Authorizations Secured Proactively:
The Engine of Performance
The biggest shift was not just in counts. It was in how cases moved through the system.
Securing Authorizations and Total Payor Communication, bServed:
- Notified payors at the right time by building and maintaining a detailed payor grid
- Sent clinical data packets in the exact formats each payor requires
- Ensured authorization decisions reflected the real clinical status early in the stay
- Protected against denials and downgrades usually caused by lagging documentation
Because these authorizations were secured in real time and aligned with the correct level of care, Providence did not just see improved volumes. It saw cleaner reimbursement on the right patients, at the right level, with the right clinical indicator support, and real-time notification for level of care sent directly to providers. This gives providers the concurrent opportunity to update their orders in relation to a payor’s decision if they agree or ground to stand on if they disagree, overturning a concurrent denial.
ZERO STRESS Multiple Service-Line Implementation:
Behavioral Health, Solved in Parallel
On top of hospital wide improvements, Providence had serious challenges in Behavioral Health. This service line has high variability, high scrutiny, and high complexity burden. Not just anyone can come in and solve these challenges.
Behavioral Health carries:
- Rapid shifts in patient status
- Stricter payor expectations
- More detailed documentation requirements
- Greater sensitivity to timing and criteria
Medical Expertise and Workforce Integration, bServed implemented a dedicated Behavioral Health solution at the same time as the hospital wide deployment.
bServed delivered:
- Real time oversight for Behavioral Health acuity and status changes
- Documentation packets formatted for Behavioral Health specific payor review
- Immediate payor communication so stays were authorized while clinical status was clear
- Physician Advisor involvement for difficult or evolving Behavioral Health scenarios
Behavioral Health became stable and predictable, financially and operationally, without disruption built on Providence’s workflows without needing to train new internal teams.
The key message: bServed implemented a complex Behavioral Health solution in parallel with a hospital wide real time review and authorization takeover, all plug and play, powered by SWARM.
The bServed Impact
Providence Little Company of Mary did not just gain more admissions. It gained better, justified, fully reimbursable admissions across the entire hospital.
Through SWARM, bServed:
- Took control of real time review and authorization starting in the ED
- Influenced every level of care decision for all admissions
- Delivered $295,000 in recovered cash
- Revealed $994,000 in additional opportunity
- Executed a parallel Behavioral Health transformation
- Achieved a verified 10X ROI
- Delivered a seamless plug and play deployment with no disruption to physicians or staff
At the center of this performance is a collaborative experience with hospital leadership who saw the opportunity and took action. Backed by Specialized Software, Workforce Integration, Authorizations, Revenue Cycle Maximization, and Medical Expertise, bServed transformed how RCM is done.