Patient access and revenue cycle support for a United States health network

The network had evaluated offshore delivery twice and stopped both times at the same obstacle: its compliance committee would not approve protected health information leaving North America, and its patient experience leadership was unwilling to accept the accent and cultural alignment trade-off on patient-facing calls. Meanwhile clinical and administrative staff were absorbing scheduling, eligibility verification and prior authorisation work, which is the most expensive possible way to do it.

We built a dedicated team in Ontario covering appointment scheduling, insurance eligibility verification, prior authorisation submission and follow-up, and denial analysis and resubmission support. Ontario gave the network full Central and Eastern time zone coverage, North American English, Spanish for its Hispanic patient population, and data that never leaves the continent.

The engagement was designed against HIPAA requirements from the outset, with a business associate agreement, documented safeguards, restricted access, and a cross-border position reviewed by the network's own compliance counsel before go-live. Denial analysis was set up as a standing weekly output with categorised root causes reported to revenue cycle leadership, rather than as a one-off project.

Dedicated team, Ontario, aligned to United States clinic operating hours across two time zones.

Scheduling line abandonment fell from a level the network described as untenable to under 4 percent. Prior authorisation turnaround improved by 43 percent. Administrative denials reduced 28 percent within two quarters as root causes were fixed rather than reworked. Days in accounts receivable improved measurably. Cost per transaction came in well below the network's fully loaded in-house cost while remaining above what offshore would have cost, which the network had accepted explicitly as the price of the compliance and experience position.

The network was not choosing between cost and quality. It was choosing between offshore savings it could not approve and in-house costs it could not sustain. Canada was the only option that resolved both, and the honest framing of that trade-off is what closed it.