Did you know that Experian does more than just provide credit scores? Experian has numerous clearinghouse data elements, including Insurance eligibility verification. Read below for more info on how we used Experian and Salesforce Health Cloud to seamlessly check patient insurance status when a care plan is entered into Health Cloud.
In this blog post, we are going to take a look at a custom Apex integration that we created for Salesforce Health Cloud. It makes use of Experian Health’s Insurance Eligibility Verification tools, which allow you to confirm insurance coverage in real-time. Visit their webpage to learn more about Experian’s insurance verification offering.
Business Background
In this example our client was a Medicaid enrollment provider that receives hundreds of self-pay patient referrals per day.
Previously, the client’s caseworkers would manually log on to state Medicaid portals. Or they would upload spreadsheets to Experian for nightly batch checking. This manual process was slow and error-prone.
The client needed an automated way to check Experian to determine if some had pre-existing coverage that wasn’t documented during the hospital intake. And the solution needed to be HIPAA and HITRUST compliant.
The Automated Process
To automate this process, we worked with Experian Health to gain access to their new insurance coverage API. We tested the API using manual tools like Postman, then created custom Apex code that follows the below sequence of events.
- The patient care plan (case) is received from the hospital via FTP
- Salesforce Health Cloud calls out to Experian to check insurance coverage
- If coverage is found, the case is moved from the main queue into a special research queue
- If coverage is not found, the system will re-check in a few weeks. (Sometimes coverage is approved by the state without notice.)
- Right before the referral case reaches the “close by” date, the system will check Experian Health one last time
Business Impact
The impact on the business was immediate. The client saved hundreds of hours of manual work each month.
Of course, this is just the beginning. Experian offers other services, including credit-checking, address validation, and more. Thanks to the Salesforce platform, integrations such as these allow businesses to do more with less.