Physical Therapy Provider Automates 100K+ Eligibility Cases in 60 Days With Active Payer Management

Before Infinx, the provider’s eligibility verification depended on staff manually navigating payer portals to gather detailed benefit data across their 1,000+ locations. Cases stacked up, staff spent hours checking portals, and downstream teams delayed moving their patients through care.

The provider knew automation could help, but automation degrades over time as payer portals change. Without active management, automation efficacy plateaus and failed cases pile back into manual queues:

• High manual workload – Spread across distributed locations with no centralized verification
• Payer complexity – Multiple portals with unique configurations and frequent changes
• Automation risk – Traditional automation breaks when payers change; fixes take weeks to deploy
• Weekend/after-hours gaps – No coverage for exceptions or failures outside business hours
• No recovery process – Failed cases became permanent manual work

The provider needed a partner who could actively manage the automation; monitoring daily, deploying rapid fixes, recovering failed cases, and continuously improving after go-live.

Infinx deployed an active management model that combined automation with continuous optimization:

High volume automation processing

• 100K+ eligibility cases processed over 60 days
• 86% efficacy for completed eligible benefit checks
• 24/7 processing (including weekends and holidays)

Rapid config fixes

• Payer-specific issues identified through daily monitoring & fixes implemented immediately
• Deployed fixes within hours for Regence, Sunflower, and Kancare
• 300 of 494 failed cases (60.7%) recovered within a weekend processing window, and root cause identified to prevent recurrence

Daily Monitoring + Continuous Optimization

• Provider & engineering teams met daily to discuss automation: performance reviews payer-by-payer, failure patterns, & scope adjustments
• Tracked which cases moved from manual to automated as fixes deployed

Processing efficiency

The switch to automation showed clear improvement to the provider’s overall case management. Infinx helped process around 100,000 eligibility cases during May–June 2026 while maintaining high quality, fast turnaround, and 24/7 continuous coverage.

Automation efficacy and quality

The provider achieved 86% automation efficacy for fully completed benefit checks and 64% contract automation overall. Efficacy improved over time through active config management.

Exception recovery and fix speed

Infinx’s 24/7 active monitoring identified 494 weekend cases requiring retry. Through immediate root-cause analysis and weekend processing, 300 (60.7%) were resolved within the same processing window, preventing them from becoming permanent manual work.

Payer portal changes are inevitable across the industry. Unlike traditional vendors who wait weeks for fixes, Infinx deployed same-day configuration updates for Regence, Sunflower, and Kancare; maintaining 86% efficacy throughout the engagement.

Continuous improvement model

Daily monitoring, transparent reporting, and joint decision-making delivered compounding gains over time. The active management approach maintained operational confidence while building the foundation for expanding into prior authorization workflows.

• Manual scope shrank with every config fix
• Avoided “set it and forget it” automation plateau
• Foundation established for multi-workflow automation expansion

Physical and occupational therapy providers are often daunted by the prospect of tackling eligibility verification.

Through Infinx’s active management model: continuous monitoring, same-day payer fixes, and 24/7 exception handling-the provider transformed eligibility verification from a manual bottleneck into a scalable, self-improving automation function that delivered sustained 86% efficacy and processed 100K+ cases in 60 days.”