Sohar Health - Detailed Review

Sohar Health Overview

Sohar Health is an AI-driven platform that simplifies and automates various aspects of revenue cycle management (RCM) and insurance verification for behavioral health providers. Here are the main features and how they work:

Insurance Eligibility Verification

Sohar Health’s API-based platform provides real-time eligibility (RTE) checks with a median latency of just 6 seconds, and 90% of eligibility checks are returned within 30 seconds. This feature ensures that healthcare providers can quickly determine if a patient is eligible for care and what their insurance coverage entails. This automation reduces the time and resources spent on manual eligibility checks, increasing patient intake and streamlining the admission process.

AI-Powered Verification of Benefits (VoB)

The platform offers AI-powered Verification of Benefits, which goes beyond basic eligibility checks to provide detailed information about the patient’s benefits, including coverage specifics and any limitations or exclusions. This feature helps providers accurately determine the patient’s responsibility for healthcare reimbursement and ensures that claims are submitted correctly to avoid denials.

Advanced Payer Intelligence and Carve-Out Detection

Sohar Health’s proprietary payer intelligence system analyzes historical data and leverages subject matter experts to identify potential carve-outs. Carve-outs occur when certain services are managed by a different entity or payer. The platform automatically checks for indications of carve-outs during the verification process and confirms the patient’s benefits with the relevant parties. This helps providers avoid submitting claims to the wrong entity, reducing claim denials and ensuring proper reimbursement.

Network Status Management

The platform helps healthcare providers determine their network status with respect to carve-outs. Even if a provider is in-network with the primary payer, they may not be in-network with the third-party administrator handling the carve-out. Sohar Health’s system clarifies these relationships, ensuring providers are aware of their network status and can submit claims correctly.

AI-Powered Medical Coding

Sohar Health also offers AI-powered medical coding, which automates the coding process for behavioral health services. This feature improves coding accuracy, reduces the time spent by coding teams on manual operations, and helps unlock up to 20% additional revenue through reduced claim denials and improved coding accuracy.

Integration with Payers

Similar to platforms like Stripe and Plaid, Sohar Health provides direct integrations to payers. This empowers developers to streamline interactions between healthcare providers and payers, reducing the need for costly and time-consuming manual integrations. These integrations help improve the accuracy of RCM processes and generate more revenue for behavioral health companies.

Conclusion

In summary, Sohar Health’s AI-driven platform automates and enhances several critical processes in the revenue cycle management of behavioral health providers. By providing real-time eligibility checks, accurate VoB, advanced payer intelligence, network status management, and AI-powered medical coding, Sohar Health helps reduce claim denials, increase patient intake, and generate additional revenue, all while minimizing manual efforts and improving overall operational efficiency.