Pre-service revenue readiness for specialty practices
Make tomorrow’s schedule financially ready.
PayerLoom’s live diagnostic reviews an uploaded schedule for eligibility and selected payer-risk findings. Design-partner pilots add automated T-48 checks, an exception-only worklist, and human-reviewed resolution tracking.
Live now: uploaded-schedule eligibility and selected payer-risk findings. Pilot scope is clearly labeled throughout this page.
Design-partner pilot example
Pre-service readiness
10
financially ready
4
need action
Coverage inactive
ActionVerify current coverage
Prior auth required
ActionStart authorization follow-up
Member information mismatch
ActionReconcile practice and payer data
Payer unavailable
ActionRetry before service
In the pilot workflow, the 10 ready appointments stay out of the default work queue.
Design-partner pilot workflow
In the pilot: from tomorrow's schedule to a resolved exception list.
The pilot tests a focused operating loop: automated T-48 checks, an exception-only worklist, assigned next actions, and human-reviewed resolution tracking. These workflow capabilities are not presented as generally available today.
01
The schedule arrives
Upcoming appointments are imported before the service date so staff do not need to re-key a second intake list.
02
Payer checks run
PayerLoom evaluates available eligibility and readiness signals approximately 48 hours before service.
03
Only actionable exceptions become work
Financially ready appointments remain a summary count. Problems receive a reason, next action, owner, and deadline.
04
Resolution is measured
The team records what was corrected, escalated, rescheduled, or left unresolved before the service date.
Truth before breadth
What is live, what is in pilot, and where the platform is going.
We separate working capability from design-partner scope and future direction. Payer policy and workflow decisions remain human-reviewed.
Live now
Schedule-based eligibility diagnostic
Upload or send a schedule and review patient- and appointment-level eligibility plus selected schedule-risk findings.
Design-partner pilot
T-48 exception workflow
Automated schedule intake, pre-service checks, an exception-only worklist, human review, and structured resolution tracking.
Platform direction
Schedule-to-payment evidence
As reliable claim and remittance data becomes available, connect pre-service issues and interventions to downstream payment results.
Specialty focus
Built for scheduled services where payer friction threatens care and payment.
Pain management
Procedure readiness, authorization risk, benefit limits, payer mismatches, and supporting-evidence review.
Orthopedics and spine
Surgery and procedure readiness where missing authorization or evidence can delay care and payment.
Cardiology
Test and procedure readiness for authorization-heavy, payer-sensitive scheduled services.
Design-partner pilot operating model
In the pilot, your team keeps control of every payer decision.
The pilot uses PayerLoom to identify and prioritize the work. Your staff reviews and resolves it. Practices that want additional operational help can separately add managed execution through Portiva.
PayerLoom does not provide medical, legal, coding, or reimbursement advice. Coverage and payer policies require human verification.
Design-partner pilot
Prove one workflow before expanding.
Start with a defined schedule source, one specialty workflow, clear success criteria, and a measured before-service resolution funnel.
See the pilot structureStart with tomorrow