Growing Physical Therapy Group Uses Automation For Eligibility And Prior Authorization Bottlenecks

The Problem: Physical Therapy Patients Expect Fast Access to Care

When injuries happen, patients need quick access to physical therapy providers. That means prior authorizations must be submitted and approved without delay. In today’s competitive healthcare market, patients can easily seek care elsewhere if appointments aren’t available quickly.

One growing physical therapy group with dozens of clinics and 50,000 visits a week faced the challenge of obtaining prior authorizations for one-third of their patients. With plans for continued expansion, they realized adding staff alone wouldn’t solve their bottlenecks.

Infinx Offered Flexibility to Meet Their Needs

Evaluating multiple vendors, the client chose Infinx due to our willingness to design a pilot program that integrated directly with their Raintree EMR. This eliminated manual data entry and the need for multiple portals. The pilot began with eligibility and prior authorization automation at 29 clinics.

Collaboration between Infinx, Raintree, and the group’s IT and business workflow teams ensured smooth implementation.

The Turning Point: Prior Authorization Errors Led to High Denials

High denial rates due to prior authorization errors were a persistent issue. With dozens of locations, centralizing processes was critical to managing prior auths efficiently.

The group had used another automated solution for benefits verification but often faced incomplete cases when the software failed to retrieve benefits information. These gaps caused write-offs or unexpected costs to patients—an unacceptable outcome.

Unlike their previous benefits software, our Patient Access Plus solution provided complete benefit details to ensure more approvals and higher reimbursements. With the combination of our automation and specialists, we were able to alleviate the client’s issues with eligibility and prior authorization-related denials, reducing the burden of appeals on practice staff.

Raintree Integration Eliminated Manual Data Entry

Rapid growth through acquisitions further complicated workflows. The client needed a scalable, standardized process to handle eligibility and prior authorizations across new clinics.

Infinx implemented an API integration between Raintree and our system to enable real-time data transfer. Cases could be initiated directly through the EMR, eliminating duplicate data entry. Authorization details and status updates were visible in the EMR, streamlining processes.

Unlike their previous solution, Infinx provided complete benefit details, enabling more approvals and higher reimbursements. Combining automation with human oversight reduced denials and eased the burden on staff.

 The Solution: Automation Simplifies Eligibility and Prior Authorization

Our eligibility and benefits software, the Patient Access Plus Platform, integrates directly with payers to deliver real-time insurance checks and benefits details. For payers without electronic access, our agents verify details manually.

This approach ensures complete and accurate information, reducing the need for follow-ups and saving hours of staff time spent on phone calls or payer portals.

Standardization Reduces Manual Workload By 70%

Once benefit details were available, our AI-powered authorization determination engine analyzed cases and initiated requests when needed. Operations agents handled status checks and complex cases, alerting staff for peer reviews or additional information requests. Approved authorizations were updated in the EMR.

With standardized workflows and automation, the client reduced manual workloads by 70%, making it easier to scale as they added new clinics.

For patients, the change was equally significant. Timely prior authorizations meant fewer delays and cancellations, reducing the stress of rescheduling surgeries or facing unexpected financial burdens due to insurance complications.

Onboarding New Clinics with Ease

The client’s centralized system simplifies onboarding for new acquisitions. Standardized workflows make training and ramp-up easier for new staff, ensuring prior authorizations are handled efficiently from day one.

Pilot Success Drives Expansion to 700+ Clinics

After a successful pilot at 29 of their clinics, the client continued to expand utlization to all of their locations. They have grown substantially in the two years since, and now use Patient Access Plus to manage patient access at all of over 720 locations, including pediatric locations.

The result? A more efficient network, happier staff, and, most importantly, better care for patients.