From High-Risk Transition to Controlled Operation

Where It Started

This academic health system is a leading provider in Southern California, operating more than 900 beds and generating net patient revenue of approximately $2.47 billion. Known for advancing care through innovation, education, and research, the organization also maintains a strong commitment to operational excellence across the revenue cycle.

As patient volumes increase and systems evolve, the organization continually seeks solutions that reduce administrative burden and ensure accurate, timely data across all points of the revenue cycle.

The Key Challenges

During a major upgrade to its patient registration platform, the health system temporarily lost automated eligibility verification capabilities. Without automation, staff would have had to manually verify patient eligibility, increasing FTE requirements and increasing the risk of errors. Any delays in verification threatened patient access, billing timelines, and revenue capture.

Healthcare operations are always under pressure to do more with less. Automating repetitive tasks allows teams to focus on the work that truly requires their expertise.

The SparkChange Approach

SparkChange deployed Advanced Eligibility Verification Automation, a sophisticated solution that analyzes raw payer eligibility response data and takes direct action on patient accounts. The automation runs every 15 minutes and monitors all non-discharged patient accounts from 30 days prior to registration to 30 days after registration.

By intelligently identifying updated eligibility data and routing exceptions for review, the automation enables registration and HIM teams to maintain high accuracy without adding manual workload.

Results

From April 2024 through September 2025, the automation delivered measurable operational and financial impact. It systematically corrected and updated patient, plan, and financial data while intelligently flagging exceptions for review. (see “automation impact”)

By eliminating repetitive manual work, the organization improved data accuracy, accelerated patient access, and streamlined registration and billing workflows. The benefits extended downstream, supporting cleaner data and faster revenue capture.

Continued Partnership

Advanced Eligibility Verification Automation has become a strategic operational asset. SparkChange continues to enhance the solution, identify new automation opportunities, and drive long-term improvements. Together, this partnership demonstrates how intelligent automation can support accuracy, efficiency, and patient-centered operations at scale.

Risk Factors

Loss of automated eligibility verification during a system transition

Complexity and limitations in the existing platform configuration

Significant cost impact if manual FTEs were required

Compressed timeline aligned with platform go-live

Risk of delayed registration and billing affecting patient access

Automation Impact

Correctly sets verification status fields

Updates or corrects policy numbers, group numbers, and plan names

Flags potentially incorrect health plans

Applies localized intelligence to automatically update or correct health plans

Updates copay, deductible, and remaining deductible using provider and appointment-type logic

Updates medical group and primary care physician information

Routes exceptions for manual review when required

Key Outcomes

376,219 encounter health plans updated

638,922 actions automated

More than 18,800 FTE hours saved

$470,000 in FTE cost savings

ROI of 58.78x