Cornerstone Cut Weekly Medicaid Posting from 20 Hours to 1.
Cornerstone Behavioral Healthcare in Bangor has 130 users across two locations, and they’ve been on PIMSY since 2014. A weekly Medicaid check that took 20 hours to post now takes about an hour, and denials fell by half.
Our weekly Medicaid check typically has 400-500 line-item payments. It used to take us 20 hours per week to post and reconcile. PIMSY has taken that down to about one hour.
Phoenicia K., Senior Medical Billing Team LeadCornerstone Behavioral Healthcare
Challenge
Cornerstone was billing private insurance, self-pay, medications for opioid use disorder, and Opioid Health Home services by hand, for contracted providers across Maine. Charts sat on an older record system, and the two locations kept their own records, so someone was always chasing a missing authorization or an unposted payment.
Solution
They partnered with PIMSY in 2014 and are still on it. PIMSY posts 835 remittances, tracks authorizations in bulk, checks eligibility before the visit, and submits claims electronically, including MaineCare. Maine’s statewide health information exchange runs in the background, so providers can see the client’s information when care crosses organizations.
Results
Denial rates dropped 50%, and Phoenicia K. said a typical weekly Medicaid check of 400 to 500 line items used to take 20 hours to post and reconcile. PIMSY brought that down to about one hour, and she said the 835 replaced about 15 hours of manual posting.
Two locations and a contractor network
Cornerstone Behavioral Healthcare is based in Bangor, with two locations and about 130 people on the system. Staff and contracted professionals provide outpatient and group therapy, behavioral health home and case management, psychological testing, medication management, and substance use treatment, including medications for opioid use disorder and Opioid Health Home services.
Before 2014, private insurance, self-pay, MOUD, and OHH all had to be posted by hand. Clinicians were documenting in an older record system, and staying current with Maine and federal rules took extra checking. The two locations kept separate records, so details did not follow the client, and coordinating the contractors took steady manual work just to keep claims accurate and payments applied.
835 posting, bulk auths, and Maine’s HIE
Cornerstone brought PIMSY in during 2014 so billing could cover that contractor network, and they have been on it for 13 years.
PIMSY posts 835 remittances, which took line-by-line remit entry off the billing week. Eligibility is verified before a service is billed, claims are checked for errors before they go out, and submission is electronic, including MaineCare. Authorization tracking runs in bulk, so the team can report which providers need a new authorization without opening every chart.
Maine’s statewide health information exchange is connected and runs during ordinary work, so providers can see a fuller client record when care crosses organizations.
PIMSY has taken our authorization tracking to a new level. Working with authorizations in bulk saves us a lot of time, and we can produce accurate reports for our providers for new authorizations that need to be requested.
Phoenicia K., Senior Medical Billing Team Lead
Denials fell, and the posting hours came back
After billing moved onto PIMSY, denial rates fell 50%, and Phoenicia said a typical weekly Medicaid check has 400 to 500 line-item payments. Posting and reconciling that check used to take 20 hours a week, PIMSY brought it down to about one hour, and she said the 835 replaced about 15 hours of manual posting.
| Measure | Change |
|---|---|
| Denial rate | Down 50% |
| Weekly Medicaid check | 400-500 line-item payments |
| Posting and reconciliation | 20 hours a week to about 1 hour |
| 835 posting | Replaced about 15 hours of manual posting |
| Users | 130 |
| Locations | 2, headquarters in Bangor, ME |
| On PIMSY | Since 2014 |
Ready to see this on your Medicaid checks?
Cornerstone needed MaineCare posting and authorization tracking that a contractor network could keep up with, and PIMSY has been doing that work with them since 2014. Schedule a demo and we’ll show you what that looks like for a practice your size.
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