Client Overview 

Tellica Imaging, a subsidiary of Intermountain Health, provides high-quality, affordable imaging services to patients across several U.S. states. 

Since its inception in January 2021, Tellica has grown rapidly, serving thousands of patients and earning an impressive 4.9/5.0 rating on Google with over 5000 reviews for its accessibility and top-tier care. 

However, rapid growth and healthcare's complexity required a sophisticated approach to Revenue Cycle Management (RCM). Tellica turned to ENTER, an AI-powered RCM platform, to address their needs.

Challenges

As Tellica rapidly expanded, they encountered several hurdles with their RCM processes, specifically due to the complexity of healthcare insurance billing, unique payer needs, and the complexity of medical coding. 

When launching, Tellica’s leadership wanted to become a national imaging provider, and they leveraged ENTER’s expertise to create novel and innovative workflow. Tellica sought a partner that could onboard quickly, share best practices, and manage the intricate processes of billing, payer contracting, and claims adjudication.

Key Challenges:

• Navigating the complex world of insurance billing and claims submissions.
• Partnering with an RCM provider that could match their fast-paced growth.
• Ensuring accurate, timely claims submissions and payments.
• Reducing operational errors and scaling without a significant increase in headcount.
• Partner with Tellica’s EMR vendor to automate the entire RCM process
• Integrate with Intermountain Health’s Financial Reporting infrastructure to provide real time data portability

ENTER’s Solution 

ENTER's AI-powered RCM platform was critical for setting up the appropriate architecture. It offered a scalable, intuitive solution for managing the full cycle of healthcare revenue management, from claims submission to payment processing. Key highlights of ENTER's involvement included:

1. Onboarding and Rapid Integration
   From the first interaction with ENTER’s COO, Brad M. Isaacson, Tellica was confident in ENTER’s ability to meet their RCM needs. ENTER provided swift integration, training Tellica's team, and even assisting their EMR vendor in processing claims, ensuring Tellica could bill and collect payments efficiently from day one.

2. Reducing Errors and Enhancing Compliance
   ENTER uses a sophisticated system to check for inconsistencies in claims and discrepancies. One such example is that Tellica was being paid with a multiple scan discount clause that was not agreed to in their contract. Through their swift actions, ENTER recovered significant revenue that would have otherwise been lost. Additionally, Tellica saw a 14x reduction in error rates thanks to ENTER’s ability to identify coding issues and other risks in claims submissions. The average for initial denial rates in radiology claims is typically 15%¹.

3. Accelerating Claims Processing and Payment Cycles
   ENTER's automation capabilities reduced the time from claims submission to payment, enabling Tellica to operate with financial efficiency. Claims now move through the system in an average of just 14 minutes, compared to the industry standard of radiology claims requiring 1-5 days² to file, allowing Tellica to focus on patient care rather than chasing payments.

4. Supporting Growth and Expansion
   As Tellica expanded into new states and geographies, ENTER helped secure payer contracts in those regions, leveraging their connections and expertise. ENTER facilitated fast onboarding with new payers, ensuring that Tellica could bill new patients quickly without administrative delays. 

5. Improving Financial Reporting and Analytics
   ENTER’s platform provided Tellica with robust, real-time analytics capabilities, offering instant insights into critical financial metrics. This empowered Tellica’s leadership to make data-driven decisions and report to stakeholders with confidence.
   
   Key Benefits included:
   • Real-time access to payer mix data, allowing for quick analysis of commercial versus federal payers
   • Geographical insights, revealing patient origins across 22 U.S. states despite operating in only three
   • Detailed financial metrics, including average net claim values and service unit processing
   • User-friendly interface enabling quick access to crucial data, enhancing operational efficiency
6. ‍EMR Interoperability / Integration
   ENTER built a robust integration with Tellica’s EMR. This bi-directional integration allows ENTER to instantly and seamlessly pull data including (patient front desk payments, insurance information, prior authorizations, demographic, service, facility) along with documentation on a per encounter basis while seamlessly passing back claim adjudication results and accurate patient balances. 

Conclusion 

By partnering with ENTER, Tellica Imaging was able to overcome the challenges of revenue cycle management while scaling operations to serve thousands of patients across multiple states. ENTER’s AI-powered platform provided the automation, accuracy, and analytics needed to support Tellica’s rapid growth, positioning them for continued success in the healthcare industry.