How Hopscotch Saves 25 Hours a Week on Eligibility Verification with Nirvana

About

Hopscotch is a practice management platform that supports 100+ behavioral health clinicians across 13 states. Their platform takes on the complexity of managing a private practice for providers, so providers can focus on delivering excellent patient care. It includes features that handle admin work like credentialing, scheduling, and billing, as well as Hopscotch Play, a digital library of therapeutic games and interactive activities that make sessions fun and engaging.

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Challenge

Hopscotch Needed a Scalable Eligibility Solution for Their Growing Provider Network

Hopscotch serves as the administrative backbone for hundreds of pediatric behavioral health providers. Before partnering with Nirvana in 2023, their all-in-one platform streamlined nearly every aspect of practice management — from marketing and scheduling to billing and claim processing. However, as their provider network and patient volume grew, Hopscotch recognized the need for a more scalable verification solution.

Each week, Katie Bradford, Billing Manager at Hopscotch, meticulously reviewed hundreds of appointments to verify insurance benefits and copays for upcoming appointments. And for good reason — according to a recent survey, 96% of patients want an accurate cost estimate before treatment, and 43% would cancel an appointment without one. Because of patient expectations, it is crucial that this task was done right and in advance of appointments in order to ensure patient satisfaction.

However, this workflow became unsustainable as monthly patient visits managed through Hopscotch increased. For each appointment, Katie collected patient information, entered it into a clearinghouse system, and combed through the data output to identify the relevant coverage details and estimated copays. This manual process surfaced some key growth opportunities:

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• Collecting reliable patient information: Verifying benefits is complex because each insurance company has specific patient data requirements to confirm eligibility. The process of manually verifying one patient could sometimes extend over multiple days if a single piece of incorrect information is input. To reduce the back-and-forth with patients and payers, Katie wanted safeguards to ensure Hopscotch was collecting complete and accurate patient data at intake.
  
  
• Navigating service-level coverage details: Clearinghouses present coverage information in dense, complex documents that take significant time to parse. While Katie's expertise allowed her to find the right details for every payer and CPT code, she needed a way to streamline this process for faster verification.
  
  
• Accessing up-to-date benefit data: Clearinghouse solutions structure information using strict, predefined fields. When an insurance plan is updated with additional details — such as alternative benefit structures — these changes often get condensed into a generic "comments" section. As a result, billers must manually identify and interpret critical updates — making it easy to miss important details or extract incorrect information. This process not only added significant manual effort for Katie's team but also led to misunderstandings of the actual benefit coverage.

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While all of this work ultimately ensured reliable eligibility verification, it also took valuable hours away from supporting providers in the other ways that Hopscotch is able to.

"Every day, we had to jump through so many different hoops to achieve the same thing — check someone's insurance," explains Sheamus Dalton, Product at Hopscotch.

The team began looking for a solution that could streamline this process while maintaining the accuracy providers depend on. Early in their search, they came across Nirvana — a platform with a proven track record of automatically processing millions of benefit checks each month with 94% accuracy. Katie and Sheamus immediately knew Nirvana was the game-changing solution they had been looking for.

"We spent at least five minutes verifying every patient visit — and we manage hundreds of these a week. We were putting in so much time, and it was a major strain on our operational bandwidth." – Katie Bradford, Billing at Hopscotch

Solution

Hopscotch Drives Sustainable Growth with Real-Time Benefit Verification on Autopilot

Nirvana instantly became Hopscotch’s last-mile solution for benefit verification, seamlessly integrating with its existing system to deliver accurate coverage information in a fraction of the time it used to take. The benefit is twofold: Katie submits accurate claims and builds trust with Hopscotch providers by offering accurate patient data. On the other side, providers have peace of mind that their operations are running smoothly — allowing them to dedicate their attention to delivering quality patient care.

Rather than worrying about limited or incorrect intake data that might slow down verification, Katie now retrieves comprehensive typo-proof insurance details simply by entering the patient's name, date of birth, and ZIP code. This process remains the same for every payer, regardless of their unique data requirements, eliminating the need to hunt down patient information.

Behind the scenes, Nirvana's proprietary ML model processes demographic data and instantly queries hundreds of plans to verify a patient's eligibility. It then compiles all the relevant information about the patient's insurance plan — including copayments, coinsurance, and deductibles — into a structured, easy-to-read format. This standardized approach saves Katie five hours every day, which she previously spent searching for specific benefit details. Now, she can process more appointments more efficiently.

Thanks to Nirvana's expert billing team, patient insurance data is always up-to-date with the latest changes across insurance schemas and policies. The platform also proactively flags eligibility changes before each appointment, ensuring providers can be confident the care they administer will be covered and reimbursed.

By automatically confirming coverage with pinpoint accuracy, Katie gets valuable time back each day that she can invest in other strategic growth initiatives. These improvements don't just benefit individual organizations — they create a ripple effect throughout the healthcare ecosystem.

When practices have the right data, they can treat more eligible patients. In turn, they save valuable resources by minimizing denials due to ineligibility — a top reason for rejections — and generate more revenue to improve access to care.

"When a patient provides their insurance information, we share it with Nirvana, and the platform gives us the exact data we need. This allows us to automatically determine the correct cost estimate for each visit and scale effectively with the same headcount." – Sheamus Dalton, Product at Hopscotch

Results

Hopscotch Verifies Eligibility 99% Faster with Nirvana

With Nirvana, Katie and Sheamus transformed their internal operations to help providers offer their best care with accurate patient data:

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• 5h Saved every day
• 99% Faster verification
• 2.5x More efficient verification processes
• 1,200 Patient visits verified per month

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Moving forward, the Hopscotch team is eager to use Nirvana to partner with more payers without worrying about specific patient data requirements and complex clearinghouse documentation. The partnership will help Hopscotch grow and support more providers in building their private practice and delivering exceptional care to each client.

"What Nirvana has built and continues to grow perfectly aligns with a company like ours. They will continue to support us as we expand." – Sheamus Dalton, Product at Hopscotch