Pointcare scales to 2.5 million eligibility checks a month with Stedi
Pointcare is a leading coverage management platform. Founded in 2012, Pointcare manages coverage for more than 3 million patients across 130+ community health centers.
Those patients are members of Medicaid, Medicare, and Marketplace plans. Pointcare shows patients and health centers each patient's coverage status in real time. It also automates renewals, so patients stay enrolled and visits don't go uncovered.
About 70% of the coverage checks that Pointcare runs go to state Medicaid agencies and to the private plans states hire to administer Medicaid benefits.
Challenge
Lapsed coverage detection is one of Pointcare's main benefits.
At the beginning of each month, Pointcare runs an automated eligibility check for every patient under management. If coverage lapsed or changed, Pointcare notifies the patient so they can investigate or get new coverage.
Those eligibility checks must be fast, accurate, and reliable. How fast Pointcare can identify coverage lapses depends on how many eligibility checks their clearinghouse can process at once.
"We need to know if someone is covered at the start of the month. If we identify that someone's coverage lapsed on the 28th, that's too late. They've already had the visit," says Balu Sudhakaran, Vice President of Product at Pointcare.
"We need to know if someone is covered at the start of the month. If we identify that someone's coverage lapsed on the 28th, that's too late."
As Pointcare's patient population grew into the millions, their legacy clearinghouse took longer and longer to process their eligibility checks. It started to look less like a partner and more like a bottleneck.
"I started to ask myself – at what number of patients do we get to where we say we cannot complete a month's worth of checks by the time the month finishes?" says Balu. "I knew we needed to find a new clearinghouse to handle our checks."
Solution
That's when Pointcare turned to Stedi as that new clearinghouse.
Stedi's JSON Real-Time Eligibility Check API let Pointcare send 50 or more eligibility checks at the same time. Each check returns results in 1-3 seconds on average.
Over six months, Pointcare used Stedi alongside their existing clearinghouse, sending 60% of their monthly eligibility checks to Stedi.
Stedi could easily handle their volume. And Stedi offered better support and transaction enrollment processes than their previous clearinghouse. Both mattered as Pointcare continued to expand into new states.
"Stedi's speed, uptime, and support have been unbelievably solid. It just doesn't compare to our other clearinghouse," says Balu.
"Stedi's speed, uptime, and support have been unbelievably solid."
Results
Pointcare now runs 100% of their eligibility checks through Stedi, around 2.5 million checks a month. That volume keeps growing as Pointcare grows.
Stedi's eligibility checks also power a new patient-facing app that lets Pointcare's patients check their coverage on demand.
"We feel like Stedi is truly a partner for Pointcare. It's not the typical customer-vendor relationship," says Balu. "Stedi helps us do what we do better."
"We feel like Stedi is truly a partner for Pointcare. It's not the typical customer-vendor relationship."
Pointcare is working with Stedi to explore insurance discovery checks, which find existing coverage for a patient across payers using only demographic information, like name and date of birth.
Early results are promising – Stedi returns coverage on 40-60% of insurance discovery checks, nearly 3x the industry average.
With Stedi's infrastructure behind them, Pointcare's team can focus on the work only they can do – keeping patients covered.
"Our mission is to ensure people have the healthcare coverage they need. With Stedi, we can focus on that mission instead of worrying about whether our transactions can scale," says Balu.
"Our mission is to ensure people have the healthcare coverage they need. With Stedi, we can focus on that mission instead of worrying about whether our transactions can scale."