Is this an actual customer result?

Telehealth Practice · Multi-Specialty

Telehealth Claim Workflow Automation for Virtual Care

Illustrative Revenue Cycle Automation Scenario. This scenario demonstrates how a healthcare organization could apply revenue-cycle automation. It is not presented as an actual customer result.

The Challenge

A telehealth practice faced denials from telehealth-specific coding and billing complexity. Payer rules for telehealth varied — some required modifier 95, others modifier GT. Place of service codes differed for telehealth. Eligibility for telehealth benefits was not always the same as in-person. The evolving telehealth regulatory landscape made it difficult to stay current.

The Approach

Sarva configured telehealth-specific claim scrubbing rules covering modifier 95/GT validation, place of service 02/10 rules, and payer-specific telehealth policies.

Eligibility checks were configured to verify telehealth-specific benefit coverage.

Payer telehealth policy library was continuously updated as regulatory changes occurred.

Telehealth claims were flagged for additional review when payer policies were ambiguous or recently changed.

Illustrative Outcomes

Telehealth denial rate

Illustrative reduction from 15% to under 4%

Modifier-related telehealth denials

Illustrative near elimination

Telehealth policy compliance

Illustrative improvement through continuous policy updates

Outcomes are illustrative and do not represent actual customer results.

Key Lessons

Telehealth billing requires specialized rules that differ from in-person billing.
Continuous policy monitoring is essential as telehealth regulations evolve.
Telehealth-specific eligibility checks prevent coverage surprises for virtual visits.

See how this approach could work for your organization.

Book an RCM Automation Demo