How PayerLoom works
Find tomorrow's payer problems before care happens.
Today, PayerLoom provides an uploaded-schedule eligibility diagnostic and selected payer-risk findings. The design-partner pilot tests how those findings can feed an automated T-48 exception workflow.
Design-partner pilot workflow
In the pilot: one sequence from schedule to resolution.
The capabilities below describe the controlled pilot scope—not generally available functionality.
Receive the upcoming schedule
PayerLoom accepts a defined schedule feed or upload so the readiness check begins without staff building a second list.
Run the T-48 check
T-48 means approximately 48 hours before service. PayerLoom evaluates available eligibility and payer-readiness signals before the appointment becomes urgent.
Create only actionable work
Financially ready appointments stay out of the default queue. Exceptions receive a plain-English reason, recommended next action, owner, and service-date deadline.
Resolve or escalate
Staff or an authorized service team records what was corrected, escalated, rescheduled, cancelled, or still unresolved before care.
Measure the result
PayerLoom measures the operational funnel first. Claim and payment attribution are added only when reliable downstream data supports them.
Current boundary
What PayerLoom does today
- Upload a schedule to run eligibility checks on scheduled appointments
- Review patient- and appointment-level eligibility results
- See selected payer-risk findings surfaced for human review
Honest limits
What PayerLoom is not claiming
- Autonomous prior-authorization submission or medication-access operations
- Guaranteed denial prevention, reimbursement, or recovery percentages
- A replacement for your EHR, practice-management system, biller, or clinical judgment
- A proven schedule-to-payment outcome until real claim and remittance evidence supports it
The platform direction
From scheduled service to correctly paid claim—earned through evidence.
The long-term goal is to connect each payer problem, recommended action, human intervention, service outcome, claim result, and payment result. PayerLoom will describe that as a proven outcome only after reliable real-world data supports it.
Design-partner pilot
Prove the workflow on a real schedule.
Start with one specialty workflow, a defined schedule source, human-reviewed exceptions, and agreed success criteria.