SPRY scales insurance verification for 1,000+ rehab clinics with Stedi
SPRY is an AI-native Electronic Medical Record (EMR) and billing platform for physical therapy, occupational therapy, and speech therapy providers doing outpatient rehab.
Their software helps more than 1,000 clinics schedule patients, document visits, and collect payment.
Challenge
Medicare patients make up a large share of most caseloads for outpatient rehab providers. To ensure those patients are covered before a visit, SPRY ran eligibility checks through their previous eligibility vendor.
SPRY's previous eligibility vendor didn't support eligibility checks to the Centers for Medicare & Medicaid Services (CMS), the government payer for Medicare. That meant SPRY's providers had no quick and reliable way to check coverage or benefits for one of their most common payers.
The vendor also post-processed eligibility responses from payers before passing them on to SPRY. SPRY got the vendor's interpretation, never the payer's original. There was no way to tell what eligibility data the processing had dropped.
"We were getting their version of the response, not the payer's. We had no way to know what was missing," says Debpriyo Goswami, Data Scientist at SPRY. "The quality of our eligibility data needs to be rock solid. No gaps. For a platform running claims and documentation for 1,000+ clinics, a missing eligibility field isn't a technical footnote. It's a claim that gets denied three weeks later and a biller who has to figure out why."
The final straw was the vendor's restrictive rate limit on transactions. The vendor pooled eligibility checks and claims under one shared limit. A spike in claim submissions could prevent SPRY and their providers from running eligibility checks.
"If there were more transactions on the claim side, eligibility checks started to fail," says Debpriyo. "We can't grow our business if eligibility checks aren't reliable."
"We can't grow our business if eligibility checks aren't reliable."
Solution
To overcome those gaps, SPRY switched to Stedi's JSON Real-Time Eligibility API for eligibility checks.
The Stedi Payer Network connects to 3,500+ payers, including CMS. That meant SPRY could use Stedi to run Medicare eligibility checks directly without another vendor. Stedi's turnkey transaction enrollment process made it easy for SPRY's providers to sign up for Medicare eligibility checks.
"Stedi made it painless for our providers to attest with Medicare for eligibility checks. The whole process only took a few minutes for the provider," says Anamika Maryapgol, Product Manager at SPRY.
"Stedi made it painless for our providers to attest with Medicare for eligibility checks."
Stedi returns lossless eligibility responses. HIPAA requires eligibility checks to travel as X12 EDI, a dense data format that few developers are familiar with.
Stedi's JSON Real-Time Eligibility API accepts and returns that X12 as JSON, a data format most developers already know. For responses, that JSON includes everything the payer sent in their X12 response. Nothing is dropped.
"We're able to surface eligibility data that we weren't able to get before," says Debpriyo. "We know we're seeing all of the payer's response."
Unlike their previous vendor, Stedi gives real-time eligibility checks a separate concurrency limit from the one used for claims. A high volume of claim submissions won't throttle eligibility checks.
"With Stedi, we don't have to worry about the infrastructure for our payer transactions. Stedi is able to handle any volume we throw at it," says Debpriyo.
"With Stedi, we don't have to worry about the infrastructure for our payer transactions. Stedi is able to handle any volume we throw at it."
Results
With Stedi, SPRY can now run eligibility checks with more than twice as many payers as before. Eligibility checks stopped failing when claims got busy.
Medicare eligibility checks now run through the same API as every other payer. SPRY's providers get benefits from payers that previously returned nothing.
SPRY expects to use Stedi to run 80,000 eligibility checks per month.
"With Stedi, we can grow our business without worrying about whether our eligibility vendor can keep up," says Henish Sutaria, Head of Finance at SPRY. "Now adding clinics is just adding clinics."
"With Stedi, we can grow our business without worrying about whether our eligibility vendor can keep up."
Meet our customers and read the success stories from Stedi.
Automate healthcare transactions with developer-friendly APIs that support thousands of payers. Contact us to learn more and speak to the team.
