How Marque Urgent Care Stopped Asking Front Desk Staff to Be Insurance Experts and Drove 4x Reduction in Claims Needing Re-verification
Challenge
Marque Urgent Care runs 14 clinics across Southern California, which means navigating one of the most complicated insurance markets in the country. Medi-Cal alone requires decoding managed care: a patient hands over a card, which points to CalOptima, which points to a specific medical group. Every payer, every IPA, every edge case, multiplied across 14 locations with rotating front desk staff.
For years, that complexity landed on whoever was working the desk.
Staff had to manually verify insurance through multiple portals, sometimes two or three per patient. Getting it right required specialist-level knowledge of payer rules that most front desk staff simply didn't have. And with turnover across 14 locations, keeping everyone trained was a losing battle.
Alisa Jones, Director of Revenue Cycle Management and Contracting, had been trying to fix this since she started with Marque five years ago.
"It would take a month-long course to just cover all the bases, and we don't have that kind of time for training. We can't expect our turnover of front desk people at 14 different clinics to be able to stay up on top of all of those rules."
The result was predictable: confused staff, frustrated billers cleaning up errors on the back end, and hours lost every day to work that shouldn't require human judgment.
"Our front desk staff would say, 'I can't find the address. The address isn't in our system.' They couldn't find that one perfect payer that looks identical to 700 other payers in the system."
Marque had simplified their internal payer setup, but the verification process itself was still manual. Alisa had spent years looking for a technology partner to solve this. She kept hearing the same answer.
"'We just don't have anything like that for your region. You guys are different. You guys are too difficult. We can't do it for you.' I've been told that for years."
Other solutions said they used AI, but their automations were just using historical data to try to predict the future. They were not reasoning through the latest insurance complexity or adapting to the real time changes in the payor market.
It would take a month-long course to just cover all the bases, and we don't have that kind of time for training. We can't expect our turnover of front desk people at 14 different clinics to be able to stay up on top of all of those rules.
Solution
Marque implemented ClearPay AI across all 14 clinics to automate real-time eligibility verification and payer selection. Before a visit starts, ClearPay runs eligibility in the background, identifies the correct payer, and pushes the information into the EHR. Front desk staff confirm the patient's name and date of birth, see the verification result, and move on.
ClearPay AI helped take the pressure off the front desk staff and let them focus on getting the patient through the waiting room in a fast & friendly way.
“At first, they were very hesitant to trust it because we've been using portals since they started. That's the way they know how to verify. But they quickly saw how much time it saves them — the patient comes in, they just open up the chart and collect what they see on the insurance verification.”
Results
Front desk: from skepticism to reliance
Gabby Gamino, Multi-Site Administrator, saw the transition among front-desk staff firsthand:
"At first, they were very hesitant to trust it because we've been using portals since they started. That's the way they know how to verify. But they quickly saw how much time it saves them — the patient comes in, they just open up the chart and collect what they see on the insurance verification."
The biggest surprise was third-party insurance. Plans that used to require a phone call, 20 to 30 minutes on hold to verify, now come back automatically.
"The CalOptimas, the third-party insurances — we don't always have portals for those. Having something that tells us it's active and we can continue? Those calls used to take 20, 30 minutes. And now our team doesn’t have to call them at all."
ClearPay now returns real-time eligibility results for 94% of visits with no manual intervention required.
Billing team: trusting the data
Even before implementing ClearPay, Marque maintained an industry-best sub-1% claim denial rate. But it required significant manual checking before claims went out. Now, for major payers, billers send claims without re-verifying first.
"I'm asking them to trust the information now and just push out the claims. And we're not seeing any increase in claim denials."
That’s helped reduce the percent of claims that billers need to re-verify from 80% down to just 20%. ClearPay AI is trained against Marque’s unique patient population and payer contracts. As a result, it’s automatically selected the payer for over 378 distinct payer combinations to-date.
Patients: fewer billing surprises
Marque staff can communicate co-pay and deductible amounts to patients, and trust those numbers. Everything lives in the same Solv interface where staff already manages patient flow — they can see co-pay information in one click, with no switching between windows. Since going live with ClearPay, Marque has collected $1.1M in co-pays at time of service while maintaining an 81 NPS.
For Alisa, this is the product she'd been asking for since she walked in the door five years ago. Her advice: “I think it's a fantastic product. Everyone should be using it."
“The CalOptimas, the third-party insurances — we don't always have portals for those. Having something that tells us it's active and we can continue? Those calls used to take 20, 30 minutes. And now our team doesn’t have to call them at all.”
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