Industry
Acute Care Hospital
Challenge
Humboldt Park Health needed to improve revenue cycle performance in MEDITECH by addressing high professional claim rejection rates, recurring clearinghouse errors, inaccurate charge forwarding and routing, inconsistent authorization controls, and limited access to clinical and billing data. Configuration gaps and manual processes created preventable rework for billing teams and increased the risk of denials.
Results
Within the first quarter after implementation, Humboldt Park Health increased its Clean Claim Rate by 16% and reduced its Clearinghouse Error Rate by 22%. Updated authorization and registration controls helped prevent avoidable denials, while analytics dashboards gave operational leaders better visibility into clinical, ancillary, and revenue cycle risks.
Services Provided
Revenue Cycle Assessment & Advisory, MEDITECH, Staff Augmentation, EHR Optimization
About the Provider
Humboldt Park Health is a 200-bed acute care facility serving the Chicago, Illinois community. Accredited by the Joint Commission and designated as a primary stroke center with certification from the Accreditation Commission for Health Care (ACHC), the organization delivers patient-centered care ranging from everyday treatment to critical needs.Revenue Cycle Issues Affecting Financial Performance
Humboldt Park Health’s revenue cycle teams were spending significant time correcting preventable claim and charge issues after submission. Professional claims were being rejected at elevated rates. Clearinghouse errors were recurring. Charges were not always routing correctly, and authorization gaps increased the likelihood of denials.
The organization needed MEDITECH expertise that could address the underlying configuration and workflow issues, not simply resolve individual claim exceptions one at a time.
A Prevention-First Approach
CereCore focused on correcting issues upstream in the MEDITECH build, configuration, and workflow design so fewer errors reached the claim submission process. The team stabilized foundational revenue cycle processes, strengthened rules-based logic, and worked with Humboldt Park Health stakeholders to validate that updates supported daily operations.
Remediating Professional Billing and Charge Capture
The team tackled charge capture from multiple angles:
- Resolved charges that weren't crossing to claims across lab, surgery, and therapy departments
- Corrected charge forwarding and routing logic to ensure both professional and technical fees were billed accurately
- Implemented automated account creation and claim submission workflows
- Redesigned registration worklists to improve patient services representative efficiency
Radiology Professional Billing
CereCore implemented a complete radiology professional billing workflow, including Modifier 26 separation of professional and technical components, CPT mapping, physician credentialing and location alignment, and drug wastage and supply charge configuration for imaging and interventional radiology.
Blood Bank Billing Optimization
Working with laboratory and MEDITECH teams, CereCore reviewed blood bank billing workflows to ensure alignment with workups sent to the blood center, verified that antibody identification and antigen typing services were accurately captured and billed, and standardized bill codes for in-house testing to ensure consistent charge capture.
Strengthening Authorization and Denial Prevention
CereCore implemented payer- and service-specific authorization alerts and account checks to identify issues before claim submission. Controls for unbilled and unclassified accounts were automated, reducing manual monitoring and helping teams prevent avoidable denials earlier in the workflow.
Unlocking Data Access with Legacy Archive Viewer
CereCore implemented the Legacy Archive Viewer to give HIM, compliance, revenue cycle, and clinical teams secure, role-based access to archived MEDITECH clinical and billing data. This improved access to documentation needed for audits, appeals, and continuity during system upgrades and expansions.
Business & Clinical Analytics
CereCore developed custom dashboards to help leaders identify clinical, ancillary, and revenue cycle risks with less manual reporting. Rapid-response reporting capabilities supported urgent operational needs, while ongoing stakeholder engagement helped ensure the dashboards reflected Humboldt Park Health’s priorities.
Building Internal Capability
CereCore paired optimization work with knowledge transfer through joint testing, screen sharing, prioritization discussions, and coaching. This approach helped Humboldt Park Health teams understand the changes, validate workflows, and build confidence in maintaining the optimized environment.
From Optimization to Stronger Revenue Cycle Control
Humboldt Park Health improved revenue cycle performance by addressing MEDITECH configuration, workflow, data access, and reporting needs together. The organization now has cleaner claims, stronger authorization controls, better visibility into operational risk, and internal teams better equipped to manage and evolve the optimized environment.
Why It Matters
For Humboldt Park Health, revenue cycle optimization created a stronger control point between clinical activity and financial outcomes. By correcting MEDITECH configuration, claim routing, authorization alerts, reporting access, and charge capture workflows, CereCore helped reduce preventable rework before it reached claim submission. Within one quarter, Humboldt Park Health achieved a 16% increase in Clean Claim Rate and a 22% reduction in Clearinghouse Error Rate, giving leaders better visibility into revenue cycle performance and teams more reliable processes to sustain improvement.
For More
Hear from Humboldt Park Health VP of IT
Hector Rodriguez, Vice President of IT: How Humboldt Park Health's VP of IT Leads a Mission-Driven Safety-Net Hospital
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