How VANAA Transformed Clients’ Billing Chaos into Seamless Revenue Stream
7-provider pulmonary & sleep facility, Arizona
Aged-claims backlog
Credentialing & contracting gaps
Prior biller performance issues
Re-credentialed
providers realigned to the right payer networks
Automated
ERA posting with CARC/RARC rules, incl. CO45
Slack-speed
day-to-day communication & patient query support
Executive Summary
Client Profile
- 7-provider pulmonary & sleep facility, Arizona
- Aged-claims backlog
- Credentialing & contracting gaps
- Prior biller performance issues
A pulmonary & sleep practice in Arizona faced mounting revenue leakage, aged claims, and credentialing gaps, with unclear communication from its previous billing partner leaving providers frustrated and patients confused. VANAA paired AI-powered eligibility and posting tools with expert human intervention, correcting credentialing errors, resolving aged claims, and restoring seamless reimbursement flows within months.
The Problem
- Previous biller: low responsiveness, unclear instructions, no structured reporting
- Significant A/R sitting over 60 and 90 days with no recovery strategy
- Providers misaligned with participating payers, driving non-covered service denials
- Incorrect handling of adjustment codes such as CO45 and incomplete ERA enrolments
- Frequent denials from inaccurate or missing eligibility verification before services
The Solution
AI-augmented tooling, human-led execution, in the order the work happened.
01
Root-cause analysis
- Analysed denials by payer, denial code, and age to prioritize recoverable claims before timely filing limits expired
- Traced a high proportion of denials to eligibility non-compliance, incorrect posting, and credentialing gaps
- Reviewed ERA enrolment status and posting logic to uncover systematic under-posting
02
Credentialing realignment
- Escalated provider participation issues and temporarily halted services tied to non-participating payers
- Led a re-credentialing effort to correctly enrol providers with appropriate payer networks
- Realigned contracts so the right provider is linked to the right payer before services resumed
03
AI-enabled eligibility & posting
- Deployed the VANAA EV tool for real-time and pre-visit eligibility checks
- Automated ERA payment posting with rules aligned to payer CARC and RARC codes, including correct CO45 handling
- Flagged exceptions for human review, controlled, compliant automation
04
High-velocity communication
- Slack channels for day-to-day coordination, status updates, and quick clarifications
- Structured weekly touchpoints on trends, KPIs, and escalations
- Direct support for patient billing queries, handled promptly and consistently
Measurable Impact
Business Impact
Client and VANAA now operate as one integrated team, ensuring financial stability, operational excellence, and patient satisfaction. The practice enjoys smooth operations and rapid query resolution, and is expanding its collaboration with VANAA to support growth.