Start here: help us understand the front-end you manage

• Tell me about the patient populations and sites you want to protect from front-end denials
• Walk me through your registration and scheduling workflow from appointment request to check-in, step by step
• In a typical month, how many scheduled visits are handled centrally versus at the department level Options: Almost all centrally, Mostly central with some departmental, Split roughly 50/50, Mostly departmental, Fully decentralized
• Who on your team currently owns insurance verification and prior authorization work during scheduling and registration Options: Front desk registrars, Central patient access team, Financial counselors, Clinical schedulers, Revenue cycle operations, Shared model
• When did a coverage error most recently delay or cancel a procedure, and what was the immediate financial consequence
• How do you surface eligibility and authorization status today during scheduling and at check-in Options: EHR flags or notifications, Manual payer portal checks, Clearinghouse lookups, Point solution screen, No consistent signal
• Which single metric does your leadership review most often for front-end performance Options: Front-end denial rate, Authorization backlog, Point-of-service collections, A/R days, Write-off dollars

Where the money actually leaves the building

• If registrations and scheduling were perfectly accurate today, estimate how much avoided revenue you would recognize per month Options: Under $50k, $50k to $250k, $250k to $1M, Over $1M, Unsure
• Tell a story about a recent denial that clearly began with a front-end error and how it propagated downstream
• List the most common front-end error types you see, ranked by frequency Options: Wrong insurance on file, Missing prior authorization, Incomplete demographics, Incorrect benefit plan selection, Duplicate registration, Other
• On average, which scheduling touchpoint produces the most coverage misses Options: Initial scheduling, Pre-registration outreach, Day-of scheduling changes, Check-in, Pre-op registration
• On an average week, roughly how many authorizations are outstanding at the time of service Options: Under 10, 10 to 50, 51 to 200, Over 200, Unsure
• Pick the downstream impact you consider most urgent to reduce Options: Write-offs, Delayed cash flow, Increased A/R days, Operational overtime costs, Patient complaints and refunds
• Which single data point about a coverage failure would immediately change how you prioritize fixes Options: Payer name and plan, Procedure code linked to denial, Date authorization requested, Responsible staff or team, Patient financial liability amount

Who needs to change for new processes to stick

• Which single handoff or role most often causes coverage to be missed before the patient is seen Options: Scheduling to registration, Pre-reg to surgery scheduler, Registrar to financial counseling, Clinical scheduler to intake, Other
• List all roles that touch eligibility, benefits or authorization during scheduling and registration Options: Schedulers, Registrars, Financial counselors, Clinical coordinators, Revenue cycle analysts, IT/integration team, Other
• Describe the average experience level and monthly turnover for the registrar roles handling these tasks
• Name who approves workflow or field changes in your scheduling or registration systems Options: Patient access director, Revenue cycle VP, Clinical operations lead, IT/application owner, Department manager
• If ownership of verification shifted to a centralized team, what operational obstacle would be hardest to overcome Options: Staffing and headcount, Change management buy-in, System permissions, Training time, Loss of local knowledge
• Would moving verification earlier in the journey, for example at scheduling rather than check-in, be acceptable to your stakeholders Options: Yes, actively preferred, Yes, with demonstration, Maybe, needs discussion, No

Why previous technology or integration efforts failed to deliver

• Explain why past automation or integration projects did not reduce front-end denials as expected
• Identify the systems that must integrate for a solution to work in your environment Options: EHR scheduling module, EHR patient demographics, Clearinghouse, Billing system, Payer portals, Other
• Name the team or role that currently manages integration connections and who would be the contact for API access
• Are production or sandbox APIs available for your scheduling and registration modules Options: Both production and sandbox available, Only production available, Only sandbox available, No API access, Unsure
• Rate the consistency of your payer IDs, plan codes, and benefit strings across systems Options: Highly consistent, Mostly consistent with some exceptions, Often inconsistent, Highly inconsistent
• Identify the single technical or resourcing constraint that would stop this project immediately Options: No API or interface access, No project resources or SME time, Procurement or legal block, No payer test access, Other

Who else is on the table (competitive landscape)

• Describe what keeping your current approach would need to demonstrate to justify staying with it
• Select the alternatives you are actively evaluating right now Options: Incumbent vendor, Internal build, Point solution for eligibility only, Clearinghouse enhancements, Another external platform, Doing nothing
• Has anyone inside proposed building the capability internally instead of buying Options: Yes, actively proposed, Mentioned but not active, No internal build discussion
• What change or evidence from your incumbent would make you decide to stay
• Name the executive or stakeholder who is arguing to keep the current solution Options: CFO, Revenue cycle VP, Patient access director, CMO/clinical leader, IT leader, Other

What success has to look like for finance and operations

• Assuming a pilot proves it reduces downstream denials by your target, what would allow you to sign an enterprise contract that week
• Pick the primary KPI the pilot should be judged on Options: Eligibility verification rate at scheduling, Prior authorization automation rate, Authorization turnaround time, Front-end denial reduction, Point-of-service collections
• What target improvement for that KPI would make the program a clear success for you Options: 5-10% improvement, 10-25% improvement, 25-50% improvement, Over 50% improvement, Unsure
• List the acceptance criteria you will require for go-live beyond the KPI target Options: Integration stability, Data accuracy thresholds, User adoption rates, Successful payer parallel testing, Training completion
• Who is the executive that must sign off on pilot success and final rollout Options: Revenue cycle VP, CFO, Patient access director, COO, Other
• How quickly do you expect to see measurable improvement during a pilot Options: Within 2 weeks, Within 1 month, Within 2-3 months, Longer than 3 months

What must be true to start deployment on time

• Which single missing resource, connection, or approval would delay go-live the longest Options: EHR API access, Clearinghouse test endpoint, Dedicated project manager, Signed contract and SOW, Payer test credentials
• Select the technical endpoints that must be available for an initial pilot Options: EHR scheduling API, EHR patient demographics API, Clearinghouse test interface, Payer test portals or APIs, Sandbox test data
• Do you have a prioritized list of payers and procedures to target for a pilot Options: Yes, ready now, Partially prioritized, No formal list yet
• Estimate the project availability you can commit from your team during a 6 to 12 week pilot Options: Full time dedicated resource, Part time (10-20% FTE), Light support as needed, No capacity currently
• Describe any regulatory, compliance, or contract approvals that typically add time to projects like this
• If the pilot meets its targets, how many additional sites would you plan to roll out in the following 6 months Options: Single site expansion, 2 to 5 sites, 6 to 20 sites, Enterprise wide

• Solution Experience — Scheduling & Registration Walkthrough

• Run the provided scheduling and procedure scenarios through the platform and deliver an annotated comparison report of outcomes, exceptions, and estimated financial impact.
• Confirm the current state and its cost
• You confirm the demonstrated workflows remove the manual coverage rework described in Discovery.
• You accept the direction and approximate magnitude of the financial impact for your scenarios, including expected reductions in front-end denials and authorization delays.
• Provide two representative scheduling/registration records with payer responses and one example of a delayed authorization case for testing.
• Walkthrough: eligibility at scheduling with a real booking
• Walkthrough: prior authorization on a representative procedure
• You identify the technical and payer evidence that remains before a pilot can start, and agree on essential pilot success metrics.
• Schedule a 4-hour integration test window with your EHR and scheduling system test endpoints.
• Agree on pilot scope, target success metrics, and a proposed 60-day pilot timeline to validate the outcomes shown.
• Compare outcomes and estimate impact
• Validate this maps to your problem
• Agree next steps and remaining evidence

• Solution Experience — Scheduling & Registration Walkthrough
• Solution Experience Deck
• Solution Brief — Scheduling and Registration

• meeting
• slides
• document

• Integrate Eligibility Verification with EHR and Scheduling Endpoints
• Activate Real-Time Insurance Eligibility Checks
• Deploy Prior Authorization Submission and Tracking
• Implement Benefits Discovery and Coverage Rules Engine
• Deploy Patient Cost Estimation and Price Transparency
• Configure Financial Clearance and Point-of-Service Collections
• Deploy Patient Financial Counseling Workflows
• Establish Payer Connectivity and Credentialing
• Integrate Clearinghouse Connectivity for Eligibility and Claims
• Enable Medical Necessity Checking at Registration
• Normalize and Load Patient Demographics into Platform
• Train Registration and Financial Counseling Staff
• Activate Authorization and Eligibility Analytics Dashboards

Integrate Eligibility Verification with EHR and Scheduling Endpoints

• Which EHR does your organization use to host scheduling and registration (name the system you will connect via API or HL7)?
• Do you currently publish HL7 ADT or FHIR Appointment/Encounter events to external endpoints for real-time lookups? Options: Yes, No, Partially (some sites)
• Who will provide API credentials, OAuth scopes, and IP allowlist details for EHR and scheduling endpoints?
• How do your registrars perform patient lookup at check-in today (select primary keys used: MRN, enterprise ID, name+DOB, payer member ID)? Options: MRN, Enterprise ID, Name + DOB, Payer member ID, Other
• Provide the FHIR resource names or HL7 message types you expect us to map for eligibility (for example Patient, Coverage, Appointment, ADT A04).
• Specify any field-level transformations required for payer member ID, subscriber DOB, or service location NPI during mapping.

Activate Real-Time Insurance Eligibility Checks

• What is the target real-time eligibility verification accuracy threshold on 270/271 member lookups (for example 95%)? Options: >= 99%, >= 97%, >= 95%, Custom - enter below
• Are there specific payer classes to prioritize for real-time checks (Medicaid, Medicare Advantage, Commercial, Managed Medicaid)? Options: Medicaid, Medicare Advantage, Commercial, Managed Medicaid, All
• Who will maintain the authoritative payer contact list and plan code updates used for eligibility lookups? Options: You maintain, We maintain, Shared responsibility
• How many scheduling events per day should trigger an automated eligibility check at point of scheduling? Options: <500, 500-2,000, 2,000-10,000, 10,000+
• Indicate the common 271 failure modes your team sees today (member not found, DOB mismatch, coordination of benefits) so we can tune matching rules. Options: Member not found, DOB mismatch, Name mismatch, COB issues, Plan not active, Other
• Which registrar-facing error handling should be automatic (blocked scheduling) versus advisory (flag in workflow)? Options: Block scheduling, Advisory flag only, Escalate to financial counselor, Manual review required
• What measurable acceptance criteria will confirm eligibility checks are operating to scope (for example >=95% member match rate on a 100-record audit, median 270 response latency <2s)?

Deploy Prior Authorization Submission and Tracking

• Describe current prior authorization submission channels in use (payer portal, fax, EDI 278, direct API) and volumes per channel.
• Do you have existing electronic 278 (prior auth EDI) capabilities with any payers today? Options: Yes - multiple payers, Yes - one payer, No
• List the clinical documents and attachments required for auths at your highest-volume service lines (for example CPT, ICD-10, imaging report, operative note).
• Identify the payer-facing contact or team who handles authorization follow-up and appeals at your organization.
• Explain how auto-status updates from payers (authorization approved/denied) should map back into the EHR order or scheduling status (for example status code mappings).
• State the measurable acceptance criteria for prior authorization automation (for example % of auths auto-submitted, % auto-approved within 72 hours, authorization number ingested into EHR without manual entry).

Implement Benefits Discovery and Coverage Rules Engine

• List the benefit elements you need surfaced in workflow (deductible remaining, copay, coinsurance %, out-of-pocket accumulators). Options: Deductible remaining, Copay, Coinsurance %, OOP accumulator, Out-of-network benefits
• Are there local medical necessity or internal clinical rules (by CPT/ICD pair) the rules engine must evaluate? Options: Yes - we have rules, No - rely on payer rules, Partial
• Indicate who will own maintenance of benefit rule exceptions and local payer plan nuances. Options: You own, We own, Shared ownership
• Explain how benefit footnotes and plan exclusions should be presented to registrars on the scheduling screen to avoid misinterpretation.
• Provide a sample payer benefit response, plan document, or EDI 835/271 snippet we can use to validate rule parsing.
• Specify the performance threshold for rules execution at point of scheduling (for example combined lookup and rule execution <500ms). Options: <200ms, <500ms, <1s, Acceptable up to 2s

Deploy Patient Cost Estimation and Price Transparency

• Identify the source charge master (CDM) export files and formats we will use to power the estimator (for example CSV of CPT->charge, FHIR ChargeItem).
• Estimate the acceptable estimator accuracy threshold for prioritized CPT groups relative to adjudicated patient responsibility (for example within 20%). Options: <=10%, <=20%, <=30%, Custom - enter below
• Confirm who will supply payer-negotiated rates and fee schedules for contracted payers and the update cadence (monthly, quarterly). Options: You supply, We ingest via feed, Both
• Name the billing location NPI(s) and place-of-service codes that must be used for site-of-service adjustments when estimating.
• Select where estimates should be visible to patients and staff (scheduling UI, check-in tablet, patient portal, statement). Options: Scheduling UI, Check-in kiosk, Patient portal, Paper estimate, Patient statement
• Detail rounding rules and whether facility and professional components should be combined or shown separately in the estimate.

Configure Financial Clearance and Point-of-Service Collections

• Assign the team owner for financial clearance workflows (registration, centralized financial clearance, or financial counseling). Options: Registration team, Central financial clearance, Financial counseling team, Shared
• Where should guarantor splits, secondary insurances, and account hierarchies be captured for POS collections?
• Should the platform enforce payment holds or require point-of-service collections when estimated patient responsibility exceeds a threshold? Options: Require collection above threshold, Advisory only, No hold required
• Attach or state any existing self-pay, charity care, or discount policy documents that affect clearance and collections. Options: Will attach, No policy, Policy exists but not attached
• Measure the target point-of-service collection rate and average payment per visit you expect to achieve after deployment (enter % and $).
• Route failed or declined collections to which follow-up workflow (immediate payment plan, financial counselor outreach, bad debt pathway)? Options: Payment plan setup, Financial counselor outreach, Automated reminder, Bad debt referral

Deploy Patient Financial Counseling Workflows

• Clarify the escalation criteria that trigger a financial counseling referral (for example estimated responsibility > $5,000, uninsured status).
• Include the counseling session documentation and required documents (ID, proof of income, estimator output) you require counselors to capture.
• Estimate typical counseling session duration and how many FTE counselors are needed per 1,000 monthly scheduling events. Options: <15 minutes, 15-30 minutes, 30-60 minutes, 60+ minutes
• State whether estimate outputs should be integrated directly into counseling scripts and used to create installment plans within the EHR or billing system. Options: Yes - integrate, No - manual only, Partial integration
• Choose the patient communication channels to use for counseling outreach (phone, SMS, secure portal message, email). Options: Phone, SMS, Secure portal, Email
• Describe approval thresholds for payment plans and discounting that counselors may authorize (dollar or percent limits and required approver).

Establish Payer Connectivity and Credentialing

• Document the prioritized list of payers to connect at go-live including payer ID, plan codes, and top contact for testing.
• When do you expect payer credentialing and trading partner setup to be complete for the top-priority payers? Options: <2 weeks, 2-4 weeks, 4-8 weeks, 8+ weeks
• Choose the connection method you prefer per payer (direct API, EDI X12 via clearinghouse, payer web portal automation). Options: Direct API, EDI X12 via clearinghouse, Portal automation, Hybrid
• Document any existing payer testing agreements, EDI trading partner IDs, or certification evidence already in place.
• Clarify responsibility for enrollment and payer certification tasks (we perform enrollment, you provide payer contacts, or joint), and name the owner. Options: We perform, You perform, Joint
• Attach proof of provider NPIs, taxonomy codes, and service location addresses required for payer enrollment. Options: Will attach, No attachments, Already on file

Integrate Clearinghouse Connectivity for Eligibility and Claims

• Where is your current clearinghouse endpoint and trading partner ID for eligibility (270) and claims (837)?
• Select which X12 transactions should be routed through the clearinghouse for go-live (270/271, 278, 837P, 835). Options: 270/271, 278, 837P, 835
• When do you expect payer acknowledgements and 271 responses to be returned under current clearinghouse SLAs (seconds, minutes, hours)? Options: Seconds, Minutes, Within 1 hour, Within 24 hours
• Name any clearinghouse vendors or gateway providers you currently use for claims and eligibility routing.
• Confirm whether you prefer direct payer API connectivity for eligibility or routing via your existing clearinghouse for each payer. Options: Direct API preferred, Use clearinghouse, Hybrid by payer
• Detail the file transfer or API methods used for batch eligibility or claim submissions (for example SFTP credentials, AS2, REST API).

Enable Medical Necessity Checking at Registration

• For which service lines do you require medical necessity checks at registration (for example radiology, cardiology, elective surgery)? Options: Radiology, Cardiology, Surgery, Oncology, Other
• Does your organization maintain local medical necessity rule sets or rely on published LCD/NCD documents from payers? Options: Local rule sets, Rely on LCD/NCD, Combination
• Submit sample clinical criteria documents or CPT+DX pair lists we should ingest for automated necessity checks.
• Confirm how ICD-10 and CPT modifiers should be mapped when evaluating medical necessity at scheduling.
• Define the override workflow when a necessity check fails but the clinician requests proceeding (required documentation, attestation fields).

• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Subscription Agreement / Order Form
• Service Level Agreement (SLA)
• Data Processing Agreement (DPA) — HIPAA Business Associate Addendum
• Payer Connectivity & Integration Responsibility Agreement
• Acceptance & Go‑Live Readiness Certificate
• Payment Schedule and Invoicing Terms
• Change Order Agreement

• Go-live Health Check
• First Measurement Review
• Acceptance Gate Review (Day 90)
• Quarterly Success Review

• Share the quarterly metric pack that includes raw data sources, calculations, and a short narrative of drivers behind any major changes.
• Produce a documented acceptance decision with pass/fail status for each acceptance criterion recorded in Solution Scope.
• Capture the buying owner's formal acceptance signatory and timestamp for the documented decision.
• Define remediation plans with target resolution dates for any criteria that are conditional or failed.
• Publish the acceptance decision document with pass/fail per criterion and the recorded signatory and timestamp.
• List remediation tasks for any non-passing criteria with success conditions and target completion dates.
• Schedule a follow-up check to validate remediation completion before closing the acceptance loop.
• Trend review versus Solution Scope targets
• Confirm whether the three named metrics are sustaining the gains required by Solution Scope or require further remediation.
• Ensure recurring technical or operational blockers are captured in the backlog with target resolution windows.
• Agree the set of backlog items to schedule in the next delivery window and the acceptance criteria for each.
• Update the enhancement backlog with priorities, estimated delivery windows, and success criteria for each item.
• Schedule targeted payer validation or parallel testing for payers causing the largest verification failures.
• Re-confirm deployment scope and owners
• Confirm all critical integrations are available or have documented remediation plans.
• Verify initial user onboarding status and collect first-week usage logs to feed the first measurement.
• Document high-severity blockers with agreed remediation steps and timelines.
• Publish a defect register with reproduction steps, severity, and resolution target dates.
• Collect and share weekly active user count, sample registration logs, and verification request volumes for the first measurement meeting.
• Confirm test payer list and schedule any required parallel testing windows with payers.
• Present first measurement data
• Agree whether eligibility verification rate trajectory is on track to meet the target recorded in Solution Scope, or document specific gaps.
• Agree corrective actions and timelines to reduce authorization turnaround time to meet the target recorded in Solution Scope.
• Confirm the data definitions and sources for the presented metrics so subsequent reviews use consistent calculations.
• Produce a prioritized remediation plan listing fixes, test steps, success criteria, and target completion dates.
• Deliver a data dictionary for eligibility verification rate and authorization turnaround time with source queries and calculation logic.
• Schedule targeted parallel testing sessions with top 5 problematic payers to validate fixes.
• Restate acceptance criteria and numeric targets
• Integration and endpoint validation
• Present outcome data for each criterion
• Persistent issues and payer connectivity health
• Root cause analysis of any gaps
• Enhancement and remediation backlog
• Short-term remediation plan
• User onboarding and early usage patterns
• Document pass/fail per criterion and capture acceptance
• Data quality and reporting sanity checks
• Agree remediation plan for any failed or conditional items
• Action plan and next quarterly objectives
• Open issues and escalation paths
• Agree next steps toward first measurement