How AI Eligibility Checks Found Hidden Revenue

A multi-site primary care group operating under value-based care contracts in South Florida faced a quiet but costly problem: members were transferring to competing practices, and the organization was often the last to know.

Sword Intelligence deployed a population-wide eligibility monitoring agent that runs continuous automated checks across all members (covering thousands of unique members per month). Each week, the agent identifies members whose eligibility status has changed and surfaces actionable recovery cases for the care team.

To address the accuracy gaps in the group’s existing system, Sword Intelligence also built and deployed an automation workaround in under two days. This new workflow completed eligibility checks for the same patient population in roughly 8 hours versus over 80 hours through the previous system, with a tech error rate below 1% versus approximately 20%. In a single week, the delta between the two systems represented over 340 undetected ineligible members: a recovery opportunity of $135,000–$270,000 that would otherwise have been missed.