Led the end-to-end modernization of a manual, paper-based EPSDT billing workflow — cutting days in A/R by 55% while eliminating administrative burden across 20 providers and 10 clinic sites, without changing a single clinical workflow.
| Before | After | |
|---|---|---|
| Submission method | Paper forms mailed to payers | Fully electronic (FHIR-based) |
| Days in A/R | 62 days | 28 days |
| Provider workflow | Manual, redundant documentation | Fully automated — invisible to providers |
| Admin burden | Multi-step handling across departments | Minimal — exception-based only |
| Annual costs | Ongoing printing, postage, handling | $10K saved annually |
| Data visibility | Limited, delayed | Real-time, structured |
HICHC is the largest Federally Qualified Health Center in Hawaii, serving patients across 10 outpatient clinics and school-based health centers distributed across the Big Island. They were conducting over 5,000 EPSDT (Early and Periodic Screening, Diagnostic and Treatment) visits annually — generating $2M+ in revenue — entirely on paper.
EPSDT billing required submitting state-mandated 8015 and 8016 forms alongside medical claims. Because no seamless electronic method existed to transmit EPSDT data and match it to the claim, every submission was manual:
The State had launched a web portal two years earlier, but adoption failed statewide — it required staff to manually key in EPSDT data through a complex onboarding process. It didn't integrate with existing workflows. Nobody used it.
As Director of Revenue Management, I led this project as systems translator, project manager, and strategic integrator — aligning clinical, billing, and technical stakeholders across multiple organizations.
The first decision was that providers would not change anything. No new forms, no new steps, no retraining. The solution had to be built entirely around data already captured in Epic — invisible to clinical staff. This constraint drove every subsequent decision.
In collaboration with Health Choice Network (HCN), we developed a CSV-based automated data extract that mapped EPSDT-required data elements directly from existing EHR documentation — enabling seamless, repeatable export without any manual intervention.
Rather than adopting the failed state portal, I advocated for a FHIR-based interoperability solution. Partnering with Hawaii Health Information Exchange (HHIE) and PACXA, we built secure system-to-system interfaces that automated transmission directly from Epic to the State Department of Health EPSDT portal.
The EPSDT form required a vaccine status field that didn't exist in Epic's structured data. I designed and implemented a custom vaccine status SmartPhrase, standardizing how providers documented vaccine completion or deferral — enabling the automation and improving consistency of public health data in a state where vaccine hesitancy is a known concern.
While clinical workflows remained untouched, billing operations were rebuilt: electronic processing via the EPSDT portal, SFTP-based error handling and reconciliation workflows, unique claim reference ID retrieval, and standardized operating procedures for exception management.
Beyond the numbers: 20 pediatric providers saw their documentation burden reduced without changing anything about how they work. 10 geographically distributed clinic sites moved off a process that required physical mail and interoffice logistics. The state gained a scalable electronic EPSDT model with real-time data for tracking well-child visits and immunization rates.
This engagement was at an FQHC — 10 sites, multi-system integrations, a 9-month build. The scope was institutional. But the underlying problem — manual workflows burning staff time, aging AR, revenue sitting uncollected because nobody has capacity to chase it — is exactly what we see in independent practices every week.
The difference is that fixing it for a 2-provider family medicine practice doesn't require a 9-month build. It requires a senior operator who has done this before, and the tooling to work through your AR fast. That's what Pacific Revenue Partners does.
A 30-minute call. We'll look at your specific numbers — AR aging, denial categories, payer mix — and tell you honestly what we think we can recover.
Book a discovery callIf we don't think we're the right fit, we'll say so on the call.