Advocates reduces billing workload and saves hours daily with Smartsheet

In 1975, friends and families of people living at Westborough State Hospital opened a small coffee shop on the hospital grounds. It was a simple space where individuals who were hospitalized could sit together, talk, and interact outside the constraints of institutional life. That commitment to community-based support became the foundation of Advocates.

Over the past five decades, Advocates has grown and evolved. Their work in community-based day services, co-response jail diversion, family engagement, loneliness prevention, peer support, and mental health urgent care are just a few of the ways that they have distinguished themselves as a leader in the field of human services.

As a comprehensive community-based nonprofit provider, Advocates now serves more than 45,000 adults, children, and families across Massachusetts and Rhode Island each year. Their full continuum of services is flexible and culturally responsive in order to best meet the needs of individuals with autism, brain injuries, developmental disabilities, and behavioral health challenges. Advocates employs more than 2,700 staff, operates nine behavioral health clinics, 148 group homes, six family support centers, five employment/day programs, and dozens of community-based programs.

From disparate emails to streamlined billing requests

Behind the scenes, employees from Advocates’ many clinics would email the billing team every day with updates, most often when an individual’s insurance had changed and claims needed to be resubmitted. If these updates weren’t processed in time, claims could be denied or never resubmitted, leading to lost revenue, higher cost responsibility, and clinicians spending valuable time chasing billing issues instead of focusing on therapy.

With 10 to 15 requests arriving daily—mixed in among dozens of routine messages—critical emails were sometimes buried or overlooked. “We also lacked visibility into the status of each billing request,” explains Danielle Joseph, Senior Director of Project Management at Advocates. “Tracking progress meant digging through email threads just to understand what had been done—and by whom.”

To accelerate billing, Advocates implemented Smartsheet, with support from Smartsheet’s Hack for Good initiative, a pro bono program that donates solutions to nonprofits, to strengthen and refine their system. Working with Smartsheet specialists, the team replaced their email-based process with a centralized, intelligent request tracker.

Clinic front office staff and clinicians now submit billing inquiries through a standardized form. Each request is automatically logged, assigned, and tracked through resolution. The billing team receives notifications when new requests are submitted, ensuring they can respond quickly. “Automated reminders ensure nothing slips through the cracks,” shares Lisa Cuddy, Revenue Cycle Manager at Advocates. Just as importantly, the system closes the loop by notifying clinics when issues are resolved.

Enterprise-grade visibility

With Smartsheet, Advocates has an instant, complete picture of each request. “Previously, we would receive emails with incomplete information and similar, uninformative subject lines, and they would all blend together,” explains Cuddy. “The system captures all the relevant information upfront, from individual details to a clear description of the issue.”

This transparency makes it easy to track and manage progress. Dashboards show which requests are open, how long they’ve been pending, and who is responsible. “I can glance at metrics like request age and type,” says Cuddy. 

“During our weekly meetings, I point out items that have been open too long and ask for updates. Smartsheet helps me hold people accountable and ensure work is evenly distributed. Ultimately, it keeps everything organized.”

Less admin, more patient care

With an automated, standardized system, Advocates has significantly reduced the administrative burden. “Previously, I could spend an entire day just managing emails,” notes Cuddy. “I no longer have to scroll through endless threads. Currently, Smartsheet probably saves three to four hours per person per day.” For a four-member team, that’s more than 15 hours saved daily.

The impact has been especially noticeable for medical staff. “Clinic directors appreciate receiving updates on what was done and who resolved the issue,” Cuddy notes. Meanwhile, clinicians have gained peace of mind. “Previously, they had to relay information back and forth between the client and the billing department, which left them feeling stuck in the middle,” she explains. Now, once clinicians submit all the necessary details through Smartsheet, the billing team can contact the client directly. 

“Clinicians feel a sense of relief. They can focus on therapy instead of administrative work,” Cuddy adds.

A single system of execution

Advocates is already expanding the system beyond the billing team. Other departments have expressed interest in adopting similar systems to manage inquiries, many of which still rely on email. “It would be incredibly powerful to standardize how requests are managed across the organization and bring those insights into shared, enterprise-grade, intelligent dashboards,” says Joseph. “That level of visibility would help us identify bottlenecks and improve how work moves across teams and ultimately strengthen how we operate so we can expand our collective impact.”