How SonderMind Reduces Benefit Verification Failure Rate by 50% with Nirvana
50%
reduction in benefit verification failure rate
17%
increase in new client benefit verification pass rate
64 h
saved per week
“Nirvana can parse vast amounts of benefit data and translate it into clear insights that accelerate eligibility checks. Their transparency keeps our billing team nimble and gets our patients faster care.”
— Breanna Kaiser, Associate Billing Manager at SonderMind
SonderMind is a leading provider of comprehensive, personalized mental health care for patients in all 50 states and Washington, D.C.
Their mission is to make mental health care work better for everyone through a range of services, including in-person and video therapy, psychiatric care, and science-backed self-care tools via the free SonderMind app.
Since launching in 2014, SonderMind has partnered with over 13,000 therapists and psychiatric providers and raised $183M in capital.
Patients are 10 times more likely to go out-of-network for behavioral health care than for medical care. That’s why SonderMind accepts a broad range of national and regional payers across the United States.
While this approach improves accessibility, it also introduces complexity. Verifying eligibility across many payers requires deep expertise and careful analysis.
To improve transparency, Associate Billing Manager Breanna Kaiser and her team built a homegrown benefit verification tool. As patient volume and payer diversity grew, the system began to break down.
Processing 270 and 271 eligibility transactions required parsing overwhelming amounts of data. The system struggled with nuanced billing scenarios like inactive coverage and carve-outs. When rules were adjusted for one payer, they were often incorrectly applied to all payers—leading to thousands of denied claims.
Correcting these errors required hours of manual work, constant data updates, and complex retraining, creating a steep learning curve for new employees.
The lack of high-level visibility also made it difficult to prioritize urgent verifications, forcing the team to chase inactive coverage updates and loop in patients—risking delayed care.
“Our benefit verification system couldn’t adapt to our processes and created endless manual work for our team. Nirvana built us a fully customized fix.”
Nirvana onboarded SonderMind with a benefit verification solution precisely tailored to their workflows. Breanna’s team can now accept a wide array of payers without risking system-wide failures or delayed care.
Nirvana’s OneVerify software integrates directly with payers to automate benefit verification and post-claim checks. Using AI and machine learning, the system analyzes data from thousands of unique health plans and verifies eligibility with 94% accuracy.
All coverage details and cost estimates populate the OneVerify interface once verification is complete.
Despite the automation, Nirvana handles complexity with precision. The system detects inactive coverage before appointments, manages carve-outs without manual work, and automatically updates inaccurate patient data.
“Nirvana processes unique situations without missing a beat. Its sheer agility saves us so much time and makes it easier for me to onboard new employees.”
The platform also gives Breanna’s team control when needed. Using override functionality, they can flag special payer scenarios—such as Aetna plans requiring third-party administrator approval—and route them appropriately without retroactive fixes.
A real-time dashboard provides a 360-degree view of eligibility metrics, including denial risk levels, top denial reasons, and failure rates across pre- and post-claim verifications. A custom new-client tag allows deeper insight into new patient verification outcomes.
Nirvana also streamlines patient outreach by flagging high-risk cases, enabling faster investigation while reducing back-and-forth communication.
Even as benefit verifications tripled within four months, failure rates continued to decline—demonstrating reliability at scale.
“Nirvana accommodates every payer and benefit structure. Now, responses are more accurate, and benefit verification pass rates are shooting up.”
By partnering with Nirvana, SonderMind significantly improved verification accuracy, reduced manual workload, and increased billing transparency throughout the care journey.
Breanna is now working with Nirvana on a new workflow management queue that will centralize benefit verification tracking, eliminating the need to download and manage results offline.
This enhancement will help the team focus on the most complex and high-priority cases—such as high denial risks and next-day appointments—while further reducing manual processes.
These updates also position SonderMind to expand its payer network, particularly with smaller regional practices that have unique benefit structures.
“With Nirvana, we can expand much more quickly in the mental health space. Their automations open up so many new partnership possibilities for us — including with smaller payers.”
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