How Geode Health Identified and Prevented 10,000 Claim Rejections with Nirvana

Learn how Geode Health gets accurate mental health benefits automatically using Nirvana’s AI-powered benefit verification technology.

“The patient journey starts with insurance verification. We need to make sure eligibility details are set before our patients even step into our office. Nirvana makes this possible.” – Jessica Beaudoin, National Coordinator at Geode Health

About

Geode Health is a leading mental health provider with 46 offices welcoming adults and children across five states. Their team partners with a range of organizations — including employers, health plans, and schools — to ensure fast, high-quality access to local care. By making mental health services accessible, affordable, and personalized, they empower patients to live healthier, more rewarding lives.

Challenge

Geode Health needed reliable verification tools to access accurate mental health benefit data

Real-time eligibility data is key for seamless patient care — especially for individuals who rely on regular sessions to support their mental health journey. That’s why when Geode Health opened their doors in 2021, they made it a priority to secure reliable coverage information that would pave the way for accessible, affordable mental healthcare. However, their existing verification process was not designed to deliver the fast, comprehensive benefit details they needed to support their vision.

To obtain accurate data, the Geode team first needed to gather patients' insurance cards. Then, they would spend hours on the phone with payers. “Many health plans manage behavioral health benefits through separate insurance providers,” explains National Coordinator Jessica Beaudoin. However, since insurance cards don’t provide this information upfront, Geode had to contact the primary care provider to find out. If mental health services were handled independently, the team faced yet another round of time-consuming calls.

But connecting with the correct payer didn’t always lead to accurate insurance data. “We’d have these lengthy phone calls, and insurance providers would still give us incorrect information,”

says Amanda Stiles, Vice President of Operations. These discrepancies increased the risk of paused or discontinued treatment due to ineligibility and unexpected out-of-pocket bills.

To ensure reliable benefit verification, the Geode team started looking for a modern verification solution. The right option would handle the nuance of billing mental health services and deliver real-time benefit data faster. But most eligibility platforms used the same manual approach as Geode, leading to inaccuracies and verification delays.

That’s when their team found Nirvana. Trained on millions of verification checks, the platform’s AI offers real-time mental health benefit data out of the box. This technology was exactly what Geode needed.

“We're practice assistants, not insurance specialists. Verifying nuanced eligibility data takes a lot of time and effort. We simply want to provide a positive patient experience without any unexpected disruptions.” – Jessica Beaudoin, National Coordinator at Geode Health

Solution

Nirvana delivers reliable coverage details for mental healthcare

Nirvana’s real-time verification transformed Geode’s eligibility checks into a smooth, highly effective process. Now, their team has precise behavioral health eligibility data at their fingertips, allowing them to deliver patient care without worries about potential treatment disruptions.

Using AI and machine learning, the platform extracts benefit details from 180,000+ unique health plans — including behavioral care benefits managed by separate payers — with 94% accuracy. “A patient may be using Blue Cross for their primary care and Magellan for mental health benefits — Nirvana helps us navigate such nuances with ease,” says Jessica.

All coverage information is directly populated into Geode’s EHR through Nirvana’s Coverage API. As a result, the Geode team no longer needs to hunt down the right providers over lengthy phone calls.

The best part? Nirvana monitors patient coverage to ensure benefit details are up-to-date at all times. For example, the platform marks patients with inactive plans seven days before their appointment. With these tools, Geode can proactively reach out to their patients to confirm eligibility, supporting continued access to care.

“Nirvana surfaces the specific mental health benefit data we need. After setting it up with our EHR, we now have the information to provide reliable care to our patients.” – Jessica Beaudoin, National Coordinator at Geode Health

Results

Geode Health verifies eligibility faster with Nirvana

With Nirvana, Geode no longer spends hours calling payers and navigating nuanced mental health coverage. Instead, they use the platform to secure accurate benefit details:

● 16h saved per month

● 95% automation of appointment checks

● 10,000 claim rejections prevented

Looking forward, the Geode team will continue to rely on Nirvana to confirm patient coverage efficiently. They’re especially excited to see how the platform’s upcoming RPA feature will further streamline their verification processes and free up more time to support their patients.

“Nirvana and Geode share a vision for frictionless mental health insurance verification and better patient care. With Nirvana, we’ve strengthened our operational foundation to ensure patients can access care without administrative barriers. We’re confident this partnership helps us expand access to affordable behavioral health services.” – Amanda Stiles, Vice President of Operations at Geode Health