What You Should Know:
– Sohar Health, a provider of eligibility determination and Verification of Benefits (VoB) solutions, today announced the launch of Network Status, a new tool designed to instantly verify whether a patient’s provider is in-network.
– The solution aims to remove a significant administrative burden for behavioral health providers, helping them reduce costs, lower insurance denials, and minimize the risk of surprise medical bills for their patients.
Tackling the “Ghost Network” Problem and Administrative Burdens in Behavioral Health
For behavioral health providers, confirming whether they are in-network with a patient’s insurance plan can be a notoriously complex, error-prone, and time-consuming ordeal. A major contributing factor is the prevalence of inaccurate insurance directories, often referred to as “ghost networks,” which frequently list providers who are unreachable or no longer in-network. One investigation, for instance, found that a staggering 86% of listed mental health providers in such directories were inaccurate.
These inaccuracies create significant barriers, preventing patients from accessing timely care and burdening provider offices with constant administrative updates to verify network participation. With adults being five times more likely to seek out-of-network care for behavioral health services, uncertainty about a provider’s network status increases the likelihood of financial risk and treatment delays for patients.
Network Status: AI-Powered Automation for Accurate Verification
Sohar Health’s Network Status tool addresses these persistent issues by employing advanced, customizable rules and API-driven automations to automatically determine a provider’s in-network status. This empowers providers to confirm coverage before delivering care, drastically reducing the manual eligibility checks that often drain time, money, and staffing resources at behavioral health organizations. Furthermore, Network Status allows providers to create custom rules tailored to their specific business needs, ensuring flexible workflows that can adapt to the often-complex nuances of behavioral health insurance plans.
“On top of delivering quality care, behavioral health providers are navigating a maze of plans, state-specific rules, and third-party administrators. Network Status simplifies this complexity into a single source of truth,” said Ashish Mandavia, CEO and cofounder, Sohar Health. “By eliminating guesswork and reducing denials, we’re helping streamline care for both providers and their patients”.
Key Benefits for Providers and Patients
The Network Status solution offers several key advantages:
- Accurate eligibility determination: Confirms whether a provider is in-network across various plans, regions, and payers.
- Customizable rules engine: Handles complex relationships and exceptions, including those involving third-party administrators.
- Time and cost savings: Significantly reduces the resources spent on manual eligibility checks.
- Increased patient satisfaction: Minimizes unexpected out-of-network bills and surprise costs for patients.
