CASE STUDY
50% Fewer Denials: The Power of Front-End Eligibility Accuracy
Graves Gilbert Clinic (GGC) Case Study
Graves Gilbert Clinic is a large, multi-specialty medical group in South Central Kentucky. They have more than 200 providers across 30 specialties. Their central billing office processes over 135,000 claims every month.
The billing team was solid. They had 45 experienced staff, offshore support for low-dollar denials, and strong processes. They even used Phreesia™ to improve patient intake and data capture.
But one problem kept coming back: registration-related denials were climbing. And leadership had no reliable way to understand why.
THE PROBLEM
Front-End Errors Hidden in Plain Sight
CFO Steven Sinclair knew the clinic was losing money on preventable issues. Nearly 65% of all denials came from eligibility, demographic, or benefits mismatches. Most should have been caught before the patient even walked through the door.
He said it best:
We are driven to eliminate denials. Groups that effectively manage denials generate accelerated revenue and minimize loss. We owe this to our providers, and patients who trust us to effectively handle the business of medicine on their behalf.
The team kept running into the same issues:
- Patients marked “eligible” in the system despite inactive or expiring coverage
- Subscriber/dependent errors that slipped through
- Missing or incomplete payer responses (orphaned files)
- Benefit details that the practice management system didn’t fully capture
The billing team was managing denials on the back end. But without accurate visibility into eligibility data, they were always reacting. Never preventing.
They needed to see errors earlier. Fix them faster. And stop preventable denials before they hit the billing workflow.
THE STRATEGY
Bring Eligibility Transparency to the Front End
Graves Gilbert Clinic partnered with Impart Knowledge. The solution was BENE•FIED™, an eligibility and benefits audit tool that makes payer responses fully transparent.
The implementation focused on three things:
Eligibility Variance Detection
BENE•FIED™ read raw 270/271 files directly from the clearinghouse, exposing issues the PMS and Phreesia™ didn’t surface — including inactive plans, expiring coverage, incorrect member details, and likely denials. It also revealed that the clearinghouse was still transmitting data in the outdated 4010 format instead of the required 5010 format.
Missing Response Recovery
The tool identified and resubmitted orphaned files through an independent connection. Staff got complete responses instead of assuming eligibility was valid. This reduced unanswered eligibility inquiries by 90% through real-time API connectivity.
Centralized Front-End Worklist
For the first time, GGC had a single queue. Every eligibility-related error was organized by priority.
One staff member could resolve issues in under 30 seconds. What used to be 30 minutes of denial rework became a quick, proactive fix.
The result? A front-end workflow that finally gave the team the accuracy and visibility they needed.
THE IMPACT
Fewer Denials, Faster Cash, and Higher Front-End Confidence
The improvements came fast. Within months of using BENE•FIED™, Graves Gilbert Clinic saw:
- Registration-related denials dropped by more than 50%
- Orphaned eligibility files decreased by nearly 90%
- Time-of-service collections increased by 20%
- Staff spent far less time fixing eligibility errors after the visit
- The billing team gained clear visibility into payer and system-level issues
- An estimated 20:1 ROI from denial prevention and faster reimbursement
For Steven Sinclair and the leadership team, the biggest win was clarity. They could finally see where eligibility failures originated—clearinghouse, payer, or internal processes. And they could address them before they turned into revenue loss.