Solutions / Patient Eligibility Platform
Patient Eligibility Platform
Coverage checked before the visit, in language the front desk can act on.
A raw 271 response is not an answer to the question the front desk is actually asking, which is: is this patient covered today, what do we collect, and does anything need prior authorization. Eligibility runs ahead of the schedule and comes back in those terms.
How the AI works
- 01
Runs off the schedule
Checks fire ahead of appointments rather than being remembered one patient at a time.
- 02
Plain-language result
Copay, deductible remaining, coverage status and prior-auth requirement — not a raw benefits blob to interpret.
- 03
Flags before the visit
Inactive coverage, a changed plan or a missing authorization surfaces while there is still time to fix it.
Humans in the loop. By architecture.
Where a payer returns something ambiguous, it is shown as ambiguous. A confident wrong copay collected at the desk costs more trust than an honest 'verify this one'.
Questions, answered
How far ahead do you check eligibility?+
Ahead of the appointment, with a re-check close to the visit, because coverage changes between the booking and the day — which is exactly where front-desk collections go wrong.
Do you use a clearinghouse for this?+
We work with the eligibility route you already have, and where a payer offers direct access we prefer it. We will also tell you when a free route does the job as well as a paid one.
Does it tell us if prior authorization is needed?+
Where the payer publishes it, yes — and that flag is the point, because a missed authorization is a denial you cannot appeal your way out of.
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