Start Where It Hurts

• Which of these best describes your role today? Options: Patient Access Director, Revenue Cycle VP, CFO, Registrar/Manager, Other
• In one sentence, what single front‑end revenue issue keeps you up at night?
• How long has this been a recurring problem for your organization? Options: < 3 months, 3–12 months, 1–2 years, 2–5 years, 5+ years
• Roughly how much annual revenue do you estimate is at risk because of front‑end errors? Options: <$100k, $100k–$1M, $1M–$5M, $5M–$20M, >$20M, Don't know / not measured
• Who on your team is currently accountable for front‑end denial rate and authorization backlog (name roles)? Options: Patient Access Director, Revenue Cycle VP, Clinical Operations Lead, Finance/CFO, Registrar Team Lead, Other

Are You Comfortable Losing Millions?

• If nothing changes, how much recurring write‑off or delayed revenue do you expect to see in the next 12 months from registration/auth failures? Options: <$100k, $100k–$500k, $500k–$2M, $2M–$10M, >$10M, Unsure — need help measuring
• Which front‑end failure types drive the most dollar impact for you? Options: Wrong payer/insurance, Missing prior authorization, Incomplete demographics/coverage data, Benefits misinterpretation, Patient estimate failures, Other
• Tell a recent story: describe one patient encounter or claim that became a high‑dollar denial because coverage was missed up front.
• What percent of missing prior authorizations are discovered at point‑of‑care versus 15–45 days post‑service? Options: Mostly at point‑of‑care (>75%), About half at point‑of‑care, Mostly discovered post‑service (>75%), We don't track this
• How does staff turnover in registration/financial counseling make these financial leaks worse?

Who's Holding the Keys?

• Who in your organization would actively resist changing current manual processes—and why might they push back?
• Which stakeholders must be involved to reach a decision and execute an automation project? Options: Patient Access / Registrars, Revenue Cycle Leadership, Clinical Scheduling, IT / Integration Team, Compliance / Legal, Finance / CFO, Executive Sponsor
• Who has final approval for vendor selection and budget for projects like this? Options: Revenue Cycle VP, CFO/Finance, CEO/COO, Committee/Board, Other
• How aligned are scheduling teams, registrars, and revenue leadership on prioritizing front‑end automation? Options: Completely aligned, Mostly aligned with some gaps, Fragmented priorities, Actively misaligned
• Which payer types or specific payers create the most operational friction for your team? Options: Commercial (large regional), National Commercial, Medicaid, Medicare, Behavioral health carve‑outs, Workers' comp, Other

When Denials Become Routine

• How often do you find your organization treating denials as 'the cost of doing business' rather than a fixable process gap? Options: Regularly — it's normalized, Often — we tolerate some, Occasionally — we fight the worst, Rarely — we actively fix them
• Approximately what share of your denials originate from front‑end issues (eligibility, auth, demographics) versus coding/clinical reasons? Options: <25% front‑end, 25–50% front‑end, 50–75% front‑end, >75% front‑end, Unknown
• On average, how long does it take your team to clear an authorization backlog today? Options: Same day, 1–3 days, 1–2 weeks, 2–6 weeks, 6+ weeks
• How do front‑end failures translate into patient experience issues (calls, complaints, surprise bills)? Give examples and frequency.
• How confident are you that your current eligibility checks are accurate at the point of scheduling/registration? Options: Very confident, Somewhat confident, Not confident, We don't have reliable checks

What Would a Miraculous Quarter Look Like?

• If you could reduce front‑end denial rate by 50% in 90 days, what would change first—financially, operationally, and emotionally?
• Which KPIs would make this project an undeniable success to you? Options: Front‑end denial rate, Authorization turnaround time, Point‑of‑service collections, A/R days, Net revenue retained, Patient satisfaction (NPS), Staff turnover in registration
• What numeric targets would you set for the top 3 KPIs above to call this a win?
• Who needs to sign off that outcomes were achieved (roles and approval level)? Options: Patient Access Director, Revenue Cycle VP, CFO, Clinical Director, Executive Sponsor
• Which data sources and reports would you trust to validate ROI and operational improvements? Options: EHR scheduling logs, Claims denial reports, Internal finance reports, Third‑party analytics, Patient billing/collections data

The Hidden Work Behind the Scenes

• How much manual effort (hours per week or FTE) does your team currently spend on eligibility verifications, payer calls, portal logins, and manual prior auths? Options: <10 hours/week, 10–40 hours/week, 1–2 FTEs, 3–5 FTEs, 5+ FTEs
• Which tasks consume the most time today? Options: Calling payers, Logging into payer portals, Manual prior authorization submission, Benefits interpretation, Patient cost estimation, Escalations to clinical staff
• What in‑house tools, scripts, or workarounds has your team built to paper‑over gaps? Please describe.
• How often do registrars need clinical staff intervention to resolve coverage questions? Options: Almost always, Often, Sometimes, Rarely
• How long does it take to onboard a new registrar to full productivity on front‑end workflows? Options: <1 week, 1–4 weeks, 1–3 months, 3–6 months, 6+ months

What Would Make You Say Yes?

• What single risk, unknown, or past vendor experience would make you stop this project before it begins?
• Which commercial or contractual terms are non‑negotiable for you? Options: SLA / uptime, Time‑to‑value guarantee, Payer connectivity commitments, Liability/indemnity, Flexible pricing / pilot pricing, Cancellation terms
• How important is broad payer connectivity at launch and which payers must be connected day‑one? Options: All major commercial, Top 3 commercial only, Medicare/Medicaid must‑have, Specific regional payers (specify), Payer coverage not critical initially
• What level of integration with your EHR and scheduling system is required for you to consider a pilot successful? Options: Deep native integration (API), Scheduled batch sync, Basic data exchange (HL7/CCD), Manual workflow with exports, Unsure — need IT input
• How do you prefer training and change management to be delivered (pick all that apply)? Options: Role‑based live training, Recorded modular training, Train‑the‑trainer, Embedded in‑app guidance, Dedicated on‑site support

Small First Steps, Big Signals

• What's a low‑risk pilot that would convince your executive team this can work (one department, payer type, or workflow)?
• Would you prefer a single‑site pilot or a multi‑site/department pilot to validate outcomes? Options: Single site / department, Multi‑site (same system), Cross‑department (scheduling + ED + clinic), Prefer vendor recommendation
• What concrete success criteria would graduate a pilot to enterprise roll‑out?
• Which stakeholders should sit on a 30/60/90 day pilot steering committee? Options: Patient Access Lead, Revenue Cycle VP, IT Integration Lead, Clinical Scheduling Lead, Finance Representative, Vendor PM
• What data cadence and format would you need during a pilot to feel comfortable (daily dashboards, weekly deep dives, claims extracts)? Options: Daily dashboard, Weekly summary + exceptions, Biweekly stakeholder review, Monthly executive report, Ad‑hoc on request

Deciding and Moving Forward

• Realistically, how soon could you start a pilot from contract signature? Options: Immediately / <2 weeks, 2–4 weeks, 1–2 months, 2–3 months, 3+ months
• What internal approvals are required before you can sign a statement of work (roles and typical timeline)?
• What reporting cadence and stakeholder updates would you expect during implementation and after go‑live? Options: Weekly operational, Biweekly steering, Monthly executive, Quarterly business review
• What would success look like at 30/90/180 days post‑go‑live? Please state one measurable outcome for each milestone.
• Is there anything else—concerns, context, or previous efforts—we should know to make our discovery and proposed pilot relevant and low risk for your team?

• Pre-Session Alignment (Solution Experience Preconditions)
• Scenario Build & Workflow Mapping Workshop
• Live Scenario Session — Eligibility Verification & Scheduling
• Live Scenario Session — Prior Authorization & Authorization Turnaround
• Consolidation & Validation Workshop (Proof -> Decision)

• Produce an itemized list of payer connectivity gaps and recommended mitigations required for pilot success.
• Agree the concrete artifacts that count as proof for each scenario (logs, screenshots, timestamps).
• Confirm field-level integration requirements and test ownership so sessions are efficient.
• Seller to produce finalized test-case spreadsheet including steps, expected system responses, evidence fields, and owner for each case.
• Customer IT to provision test EHR/scheduling user accounts, sample patient records, and payer test credentials.
• Customer to identify 6-10 real patient encounters (de-identified as needed) that represent high-risk failure types.
• Schedule a brief system-check meeting (15 min) to validate connectivity and permissions before Live Scenario Sessions.
• Session Brief & Target Metrics
• Validate that automation correctly identifies eligibility issues and triggers the agreed remediation at point-of-scheduling/registration.
• Collect concrete evidence (screenshots, logs, timestamps) that proves prevention of specific downstream denials.
• Identify and prioritize configuration, data, or integration fixes required to meet acceptance criteria.
• Document and assign critical defects to owners with expected resolution timelines.
• Seller to deliver eligibility logs and a side-by-side comparison vs baseline error examples for each executed scenario.
• Customer to confirm changes to registration workflow or registrar scripts if needed to realize automation benefits.
• Session Brief & Success Criteria
• Prove that automated prior-authorization submissions and tracking reduce authorization turnaround and manual work.
• Validate automated handling of common exceptions and confirm escalation workflows align with customer operations.
• Introductions & Objectives
• Seller to deliver a timeline analysis showing baseline vs observed authorization turnaround per scenario.
• Customer to approve prioritized list of payer connectivity work and assign IT/operations owners.
• Create follow-up tasks to resolve any data-format or document-submission failures noted in the session.
• Executive Recap: Current State to Future State
• Validate whether the future state has been proven for prioritized failure modes with concrete evidence.
• Reach a clear decision to proceed to Solution Scope/pilot or define targeted remediation and an additional validation plan.
• Assign owners, timelines, and acceptance criteria for the next phase and ensure stakeholder alignment on risks and mitigations.
• Produce a consolidated Evidence Pack (test-case results, screenshots, logs, timestamps, and impact calculations) and share with stakeholders.
• If proceeding, draft pilot scope and timeline covering payer onboarding, integration milestones, training, and pilot success metrics for sign-off.
• If not proceeding, list required remedial activities and schedule follow-up validation sessions with owners and deadlines.
• Communicate executive summary to RCM leadership and obtain formal approval to move to the next stage.
• Produce a crystal-clear current-state sentence and concrete consequence metrics to anchor the experience.
• Agree the one-sentence future state outcome that will be proven by scenario runs.
• Finalize scenario list, required test data, access, and participant roles for Live Scenario Sessions.
• Establish a pre-work checklist with owners and deadlines so sessions are productive.
• Customer to provide denial-rate metrics, top payer list, sample problematic encounters, and EHR/scheduling test access.
• Seller to prepare mapping template, scenario script templates, and configure test environment access.
• Assign session owners and observers with roles defined (registrar, financial counselor, IT, payer ops, RCM lead).
• Schedule Live Scenario Sessions and share agendas and test-case spreadsheets at least 48 hours before each session.
• Recap Preconditions & Success Signals
• Produce executable scenario scripts with clear start state, steps, and acceptance criteria for each prioritized failure mode.
• One-sentence Current State
• Connectivity & Test Patient Check
• Walkthrough of End-to-End Scheduling & Registration Flow
• Evidence Summary by Scenario
• Test Environment & Payer Connectivity Verification
• Consequence Quantification
• Quantified Impact & Risk Adjustment
• Map Failure Points to Scenarios
• Run Scenario #1..#N (Eligibility Cases)
• Execute Submission & Tracking Scenarios
• Open Issues, Mitigations, and Pilot Readiness
• Tie Outcomes to Problems
• Define Future State (Outcome-focused)
• Write Scenario Scripts
• Simulate Exceptions & Manual Escalations
• Define Measurement & Evidence
• Decision & Next Steps
• Capture Failures, Workarounds, and Config Needs
• Scenario Selection & Prioritization
• Quantify Impact & Tie Back to Consequence
• Data & Environment Readiness

• Real-time Insurance Eligibility Verification
• Automated Prior Authorization Submission
• Prior Authorization Tracking and Payer Follow-up
• Benefits Discovery and Coverage Mapping
• Patient Cost Estimation and Estimate Statement Delivery
• Financial Clearance and Point-of-Service Collections
• EHR and Scheduling System Integration
• Payer Connectivity Setup and Maintenance
• Demographics and Insurance Data Normalization
• Medical Necessity Checking and Clinical Rule Automation
• Staff Training on Patient Access Platform Workflows
• Analytics Dashboard for Eligibility, Authorizations, Denials

Real-time Insurance Eligibility Verification

• Which points in the patient journey should trigger real-time eligibility checks? Options: Scheduling, Check-in/Registration, Pre-visit financial clearance, Order entry, Multiple (select all that apply)
• What sources should be queried for eligibility (e.g., payer portals, clearinghouse, third-party APIs)? Options: Payer portals, Clearinghouse, Third-party eligibility APIs, Internal payer lists, Other (please specify)
• What is your expected daily volume of eligibility checks (average and peak)? Options: Less than 500/day, 500-2,000/day, 2,001-10,000/day, More than 10,000/day
• Which patient types should be included in real-time checks? Options: Outpatient/ambulatory, Inpatient admissions, Same-day surgeries/procedures, Imaging/Lab only, All patient types
• Which eligibility response elements must be captured and mapped (e.g., coverage active, plan type, effective dates, cost share)?
• What are the acceptance criteria for successful eligibility verification (e.g., verification rate, time-to-response)?

Automated Prior Authorization Submission

• For which service types should automated submissions be enabled? Options: Advanced imaging (MRI/CT), Surgery/procedural, Outpatient therapeutics (infusions), Durable medical equipment, All of the above
• Which payer types should support automated submission (select all that apply)? Options: Commercial, Medicare, Medicaid, Medicare Advantage, Workers' Compensation, Self-pay (internal approvals)
• Do authorizations require clinical attachments or structured clinical data for submission? Options: Yes - clinical notes/labs/images required, Sometimes - depends on payer/service, No - claim form only
• Who will own the submission workflow and required clinical documentation? Options: Ordering provider/clinic, Revenue cycle team/registrars, Central prior auth team, Hybrid/other (please specify)
• What volume of authorization submissions do you expect per week? Options: Less than 50/week, 50-200/week, 201-1,000/week, More than 1,000/week
• What is the desired SLA for submission success and initial payer response?

Prior Authorization Tracking and Payer Follow-up

• How do you currently track authorization status and follow-ups? Options: Manual spreadsheets, EHR task lists, Clearinghouse portal, Existing tracking tool, Not tracked consistently
• What follow-up cadence and escalation rules should be automated (e.g., 3-day ping, escalate at 14 days)?
• Which payers require payer-portal follow-up vs. phone-based follow-up? Options: Mostly payer portals, Mostly phone, Mixed - varies by payer, Unknown (need assessment)
• Which fields must be surfaced in tracking dashboards (e.g., submission date, status codes, due dates, assigned owner)?
• What KPI targets should tracking support (e.g., % approved within X days, reduction in manual follow-up FTEs)?
• What are the acceptance criteria for this module (reporting, SLA adherence, percent of automated follow-ups)?

Benefits Discovery and Coverage Mapping

• How granular should benefits discovery be (basic coverage vs. benefit-level per CPT or service)? Options: Basic coverage flag only, Benefit-level by service/CPT group, Detailed line-item benefits with modifiers, Other (please specify)
• Do you need mapping between payer benefit codes and your internal service/CPT lists? Options: Yes - automated mapping required, Partial - some manual mapping, No - mapping already exists
• Which benefit attributes are required (e.g., prior auth required, pre-cert rules, network restrictions, usage limits)?
• Should benefit discovery be invoked at scheduling, during insurance verification, or both? Options: Scheduling, Check-in/Registration, Both, Other
• Are there payers or lines of business with unusually complex benefits we should prioritize?
• What acceptance criteria indicate successful benefits discovery (accuracy threshold, coverage mapping completeness)?

Patient Cost Estimation and Estimate Statement Delivery

• Do you require patient estimates for outpatient visits, procedures, or both? Options: Outpatient visits, Procedures/surgeries, Both, Other
• Should estimates include patient-specific out-of-pocket (deductible, co-insurance, copay) or high-level averages? Options: Patient-specific OOP, Average/typical estimate, Both options depending on scenario
• Which channels should deliver estimate statements to patients? Options: Email, Patient portal, SMS, Printed at registration, Mail
• Do you need bundled estimates for facility + professional charges? Options: Yes - bundled, No - separate estimates, Only for specific services
• What threshold of estimated patient responsibility should trigger pre-visit financial counseling or payment plan offers? Options: Any non-zero balance, Greater than $100, Greater than $500, Custom threshold
• What acceptance criteria define an accurate and usable estimate (variance tolerance, patient acknowledgement rate)?

Financial Clearance and Point-of-Service Collections

• Should financial clearance include eligibility, benefits, authorizations, and patient responsibility collection in a single workflow? Options: Yes - single workflow, No - separate steps, Hybrid
• At what point should point-of-service collections be attempted (pre-visit, at check-in, post-visit)? Options: Pre-visit, Check-in, At time of service/checkout, Post-visit
• Which payment processors and merchant services must integrate for POS collections?
• Do you require capabilities for payment plans, cash-estimate holds, or bad-debt prevention workflows? Options: Payment plans, Cash-estimate holds, Automated charity screening, Bad-debt prevention workflows, All of the above
• Who will own collections workflows and disputes at POS? Options: Front-desk/registrars, Financial counselors, Centralized collections team, Hybrid
• What are the acceptance criteria for POS collections (collection rate targets, uptime, reconciliation accuracy)?

EHR and Scheduling System Integration

• Which EHR(s) and scheduling systems must be integrated? Please list product names and versions.
• What integration methods are supported/required (HL7, FHIR, APIs, custom interfaces)? Options: HL7 v2, FHIR, REST APIs, Custom interface/flat files, Other
• Which data elements require write-back into the EHR/scheduler (eligibility flags, auth numbers, estimated patient responsibility)?
• Do you require single-sign-on or embedded workflow UIs within the EHR? Options: Yes - embedded UI, Yes - SSO only, No - standalone application
• What are your UAT and go-live cutover requirements for integrations (parallel run, phased rollout, big-bang)? Options: Parallel / shadow run, Phased by clinic or service line, Big-bang
• What acceptance criteria define integration success (data fidelity, latency, write-back reliability)?

Payer Connectivity Setup and Maintenance

• Please provide the list of payers and payer IDs to be connected (attach separately if large list).
• Who will own payer credentialing, attestation, and portal access for setup and ongoing maintenance? Options: Customer owns, Seller owns, Shared responsibility, Undecided
• Which connection types are required per payer (API, EDI/clearinghouse, web portal scraping, manual entry)? Options: API, EDI/clearinghouse, Portal scraping, Manual
• What is the desired timeline to bring high-priority payers online? Options: 2-4 weeks per payer, 4-8 weeks per payer, Custom/depends on payer
• What monitoring and maintenance SLAs are required for connectivity (uptime, alerting, remediation windows)?
• What acceptance criteria will confirm payer connectivity success (successful test transactions, percent of payers live)?

Demographics and Insurance Data Normalization

• What are the primary sources of demographic and insurance data (patient self-report, referral forms, EHR, payer feeds)? Options: Patient self-report, Referral forms, EHR, Payer feeds, Other
• Which normalization tasks are required (name standardization, address validation, insurance ID parsing, payer name mapping)? Options: Name normalization, Address validation, Insurance ID parsing, Payer name mapping, Other
• What match/verification thresholds do you require for automated acceptance vs. manual review? Options: High (95%+ auto-accept), Medium (80-95%), Low (manual review preferred)
• Do you require real-time correction suggestions for registrars (e.g., suggested payer name or plan)? Options: Yes - inline suggestions, No - alert only, Other
• What percentage of current insurance/demographic records fail validation today (estimate)? Options: Less than 5%, 5-15%, 16-30%, More than 30%
• What acceptance criteria should be used (reduction in bad records, percent auto-normalized, downstream denial reduction)?

Medical Necessity Checking and Clinical Rule Automation

• Do you want automated medical necessity checks prior to scheduling or only during clinical review? Options: Prior to scheduling, During clinical review, Both, Not required
• What sources will define clinical rules (internal protocols, payer policies, national guidelines like LCDs)? Options: Internal protocols, Payer policies, National guidelines (e.g., LCD/NCD), Third-party rule sets
• How should exceptions and overrides be handled and documented? Options: Clinician override with reason, Clinical review queue, Auto-escalate to utilization management team
• Which data elements are required for rules to evaluate (diagnosis codes, prior treatments, labs, imaging history)?
• Do you require audit logging and reporting for rule decisions and manual overrides? Options: Yes, No
• What acceptance criteria define success for clinical rule automation (false positive rate, time saved, authorization avoidance)?

• Statement of Work (SOW)
• Master Services Agreement (MSA)
• Service Level Agreement (SLA)
• Commercial Terms & Pricing Schedule
• Acceptance Criteria & Go-Live Checklist
• Payer Connectivity & Interface Responsibilities Agreement
• Data Processing Agreement (DPA) & HIPAA Addendum
• Security & Compliance Attestation
• Training, Change Management & Knowledge Transfer Plan
• Change Order Agreement
• Implementation Timeline & Milestone Payment Schedule
• Executive Approval & Steering Committee Signoff
• Renewal, Termination & Exit Plan
• Liability, Insurance & Indemnity Schedule

• Success Kickoff & Baseline Confirmation
• Outcomes Validation Workshop (Data-Driven)
• Lessons Learned & Continuous Improvement Session
• Shared Backlog Prioritization & Roadmap
• Recurring Success Check-In (30/60/90-Day Cadence)

• Establish a prioritized, timebound backlog with owners and SLAs for each item.
• Assign pre-work and schedule the deep validation session.
• Introductions & Meeting Objectives
• Review Validation Findings Summary
• Capture actionable lessons tied to specific data points and user feedback.
• Produce a prioritized list of improvements with owners and expected impact.
• Identify immediate quick wins to reduce front-end errors in the next 30 days.
• Document and add prioritized improvements to the shared backlog with owner assignments.
• Create a 30-day quick-win implementation plan for the top 2-3 items.
• Schedule targeted training refresh sessions for registrars covering identified friction points.
• Seller to propose configuration or integration changes required and estimated effort.
• Backlog Review & Classification
• Lock the data sources and owners responsible for producing validation evidence.
• Agree clear acceptance criteria to avoid rework and ensure customer sign-off.
• Set a release and communication plan that minimizes operational disruption.
• Update the shared backlog with final priority scores, owners, SLAs, and acceptance criteria.
• Seller to schedule engineering/configuration work and provide estimated delivery dates for top items.
• Customer to confirm acceptance test participants and sign-off process.
• Communicate the roadmap and upcoming release windows to affected operational teams.
• KPI Snapshot
• Ensure KPIs remain on track and detect trend regressions early.
• Maintain throughput on the backlog and remove blockers quickly.
• Keep stakeholders aligned on next actions and upcoming risks.
• Produce a one-page KPI trend summary before each recurrence and circulate 48 hours in advance.
• Resolve or escalate any blocker older than the agreed SLA before the next check-in.
• Add any new operational or payer issues to the shared backlog with preliminary severity.
• Create one unambiguous statement of the current state that all participants agree on.
• Agree and document the measurable success signals and numeric targets to validate.
• Customer to deliver baseline data extract (denials, auth times, collections) covering agreed date range.
• Seller to provision dashboards and confirm access for all reviewers.
• Both parties to finalize the one-sentence current state and success target document in shared workspace.
• Schedule Outcomes Validation Workshop and circulate required attendee list and pre-work two weeks prior.
• Recap Current State & Targets
• Demonstrably prove (or disprove) that the platform achieved each agreed success signal against live data.
• Tie every observed outcome back to the original problem statement and quantify the impact.
• Agree on classification of gaps (bug, enhancement, workflow, payer issue) for backlog entry.
• Obtain explicit customer validation or a decision path for unresolved items.
• Seller to produce a validation report summarizing KPI performance, sample-case findings, and quantified impact.
• Customer to mark each sample case as 'validated' or 'needs follow-up' and provide any missing documentation.
• Create initial backlog entries for every gap identified with proposed owner and severity.
• Schedule targeted root-cause deep dives for high-severity exceptions within 2 weeks.
• Dashboard Walkthrough: Front-End Denial Rate
• User Experience Feedback
• One-Sentence Current State
• Prioritization & Scoring
• Open Blockers & Backlog Progress
• Define Acceptance Criteria
• Consequence Review
• Emergent Issues & Payer Variability
• Root Cause Mapping
• Dashboard Walkthrough: Authorization Turnaround
• Improvement Brainstorm
• Action Review & Next Steps
• Owners, SLAs & Escalation Paths
• Define Future-State Success Signals
• Dashboard Walkthrough: Point-of-Service Collections
• Measurement Plan & Data Sources
• Representative Case Validation
• Prioritization Criteria & Quick Wins
• Release Planning & Communication