Eligibility checked in the practice-management system, not on hold

The question this file answersWhat happens when reception is on hold with a payer and the waiting room is full?

Fits: clinics and hospital groups seeing 50–300+ patients a day.

Typical day

What the desk looks like today

Typical, from the healthcare playbook (intake). 50–300+ patients a day walk through a mid-size clinic, and each one's cover has to be verified before the visit. Reception rings the payer or uses its portal, types what it heard into the practice-management system, and learns after the visit that the plan changed. Peak is the first hour.

What changes

What Monday looks like after

At 07:45 the front desk opens a list of today's patients whose cover came back inactive or unclear — the rest were confirmed overnight. Reception still greets everyone; the time on hold is what goes.

Typical, not a measured client result. Every figure here comes from the playbook source named below.

USD 10–12

saved per eligibility check versus a manual one — CAQH Index (2023); nothing clinical

Before: reception calls the payer and types what it heard. After: cover is checked through the clearinghouse the day before; CAQH (2023) puts the saving at USD 10–12 per check — complex cover still gets a person.

No published figure for this desk. The range lives on the parent file: Intake forms into the EHR; reception keeps the greeting →

How this file is built

CAQH Index (2023) puts the saving from automating eligibility verification at USD 10–12 per transaction versus manual — a US industry figure, not our measurement. McKinsey's (2023) broader 30–40% for intake admin belongs to the registration file. Not a clinical claim.

What we install

What we put in front of the systems you already run

The practice-management system stays — Athenahealth, eClinicalWorks, NextGen or the one you run — and so does your clearinghouse, Availity, Waystar or Change Healthcare. We take one piece of the registration build and run it alone:

the day's schedule is read from the PM system
each patient's cover is checked through the clearinghouse's eligibility transaction, typically the day before
confirmed cover is written back to the patient record, and anything inactive, unclear or with a co-pay surprise is put on reception's morning list with the payer response attached.

What stays human — and what this will not do

The greeting at the desk. Complex or secondary cover. Deciding that a patient is seen regardless.

Not a clinical claim.

What can go wrong — and what we do about it

Payer responses are only as good as the payer's data; a plan that changed yesterday can still come back active, so the check reduces surprises rather than ending them. If your PM system has no eligibility interface, checks run through the clearinghouse portal — slower, and it needs your vendor. CAQH's USD 10–12 is a per-transaction saving in the US market; it says nothing about clinical urgency or complex cover.

What it costs to get there

The path: free 60-second estimate → free 20-minute review → paid audit of this one process (€1.5–3K, typically two weeks) → pilot with your people in the loop (€10–20K, weeks, not quarters). No transformation programme. Prices are public, on the services page →

Scoped in the audit — the playbook has no estimate for this exact desk.

This is about you if…

Does reception still verify cover by phone or by logging into each payer's portal?
Do you already have a clearinghouse connection your PM system can use?

What does this mean in euros?

That depends on your volumes and wage costs — this page will not invent the number. The free 60-second estimate runs that calculation from your answers, with every multiplier sourced.

Get your free savings estimate 60 seconds · no sales call Or write first → Map a healthcare process like this one — free, 60 seconds →

Not a named Aperanda client. Process file · Healthcare.

Short process file. Same build as its parent file; the playbook has no separate volume or benchmark for this desk.

All process files