Cover checked before the visit
Real-time eligibility over EDI 270/271, including plan status, deductible progress and co-pay, so nobody is treated under a policy that lapsed in March.
Use case · Payment Resolution
The balance conversation, handled without the chase.
Eligibility, estimates, statements, payment plans and denials worked through in plain language — so patients understand the bill before it arrives and the practice stops writing balances off.
- 34%
- More patient balance collected
- 58%
- Fewer billing calls to the desk
- 12 days
- Off average days in A/R
In the product
Patient balance — account 55219
ResolvingInbound 14:22 · Tomás F. · 44 · statement query
Caller
I got a bill for a hundred and eighty euro and I don't know what it's for. I have insurance.
Primum
You do, and it paid part of this. The visit on the 6th was billed at €310. Your plan allowed €245 and paid €65 of it — the remaining €180 went against your deductible, which has €420 left on it this year.
Caller
So it's not a mistake.
Primum
It isn't. I can take it now, or split it over three months at €60. Either is fine.
Caller
Split it, please.
Plan created · 3 × €60 · first payment today · card on file, tokenised
Adjudication
- Billed
- €310.00
- Plan allowed
- €245.00
- Plan paid
- €65.00
- To deductible
- €180.00
- Resolution
- 3-month plan agreed
- Posted
- €60.00 today
Ledger updated 14:27 · plan scheduled · no biller touch required
Overview
People do not refuse to pay. They refuse to pay what they do not understand.
- Cover and patient responsibility confirmed before the visit, not disputed after it.
- Statements explained in plain language, with payment taken on the same call.
- Denials triaged and resubmitted before they age out of appeal.
A statement is a number with a code beside it. The patient rings to ask what it is for, the desk cannot see the adjudication, and the call ends with 'we'll look into it'. Two statements later the balance goes to collections and the relationship goes with it.
Primum takes the whole money conversation end to end: checking cover before the visit, telling the patient what their share will be, explaining a statement line by line when they ring about it, taking the payment on the call, or setting up a plan that fits. Denials are worked in parallel — read, categorised and either corrected and resubmitted or queued for appeal while they are still young enough to win.
Capabilities
Every point where money goes missing
Revenue leaks in four places. This works all four rather than the easy one.
An estimate they can act on
Expected patient responsibility calculated from the plan and the planned service, and explained before the appointment — which is the point at which a payment plan is still an easy conversation.
Statements explained, not restated
The agent reads the adjudication and explains the balance line by line: what was billed, what the plan paid, what was applied to the deductible, and what is left.
Denials worked, not stacked
Remittance advice is read on arrival, denials are categorised, and the correctable ones — coding, eligibility, missing authorisation — are fixed and resubmitted while the clock still allows an appeal.
How it works
From eligibility to a settled balance
The same pipeline runs before the visit and after it, which is why so little ends up aged.
- Arrives
- Decided
- Done
- Returned
01
Cover confirmed
Eligibility and benefits checked ahead of the appointment, with the patient told what their share is expected to be.
EDI 270/271
02
Claim watched
Submission tracked to adjudication. Remittance advice is read on arrival and denials are categorised by cause rather than dropped into one worklist.
EDI 835 parsed
03
Balance explained
The patient is contacted, the statement is walked through line by line, and payment is taken on the call — or a plan is agreed against your own rules.
PCI-compliant capture
04
Posted and closed
Payment posted to the ledger, the plan scheduled, the account annotated, and anything genuinely disputed routed to a named biller with the history attached.
Ledger write-back
01
Cover confirmed
Eligibility and benefits checked ahead of the appointment, with the patient told what their share is expected to be.
EDI 270/271
02
Claim watched
Submission tracked to adjudication. Remittance advice is read on arrival and denials are categorised by cause rather than dropped into one worklist.
EDI 835 parsed
03
Balance explained
The patient is contacted, the statement is walked through line by line, and payment is taken on the call — or a plan is agreed against your own rules.
PCI-compliant capture
04
Posted and closed
Payment posted to the ledger, the plan scheduled, the account annotated, and anything genuinely disputed routed to a named biller with the history attached.
Ledger write-back
Benefits
Collected earlier, disputed less
The money that is easiest to collect is the money nobody was surprised by.
More of the balance arrives
Patients who were told the number before the visit and can pay on the call they already made settle at a materially higher rate than patients who get a third statement.
A/R stops ageing quietly
Denials worked on arrival rather than at month end are denials that can still be appealed. The 90-plus bucket stops being where claims go to die.
Billing stops being adversarial
An explanation and an offer of a plan turn a debt-collection conversation into an administrative one. Nobody has to be chased.
In practice
Four balances, four routes to resolved
The ones that used to become write-offs.
Deductible not met
Told before the visitThe estimate shows the full cost falls to the patient. They are offered a three-month plan two days before the appointment and take it.
Denied — missing authorisation
Resubmitted day 2Categorised on arrival, the authorisation is retrieved from the referral, and the claim is corrected and resubmitted before it ages a week.
'I already paid this'
Resolved on callThe agent finds the posted payment, sees it applied to a different encounter, explains the difference and closes the query without a biller touching it.
Plan lapsed in March
Caught at eligibilityFlagged before the visit rather than after the claim. The patient updates their cover, and the visit is billed to the right payer the first time.
Read next
- Patient IntakeRegistration, history, medications, allergies, consent and insurance collected in conversation ahead of the visit — coded, verified and written into the record, so the appointment starts with the examination.Open
- Appointment SchedulingBooking, rescheduling and cancellation handled end to end against your live diary — with the right appointment type, the right clinician, the right duration, and the preparation instructions sent before the caller hangs up.Open
- Task ManagementResults to action, letters to file, forms to complete, calls to return. Every task created, prioritised, drafted and routed — with the ones a person must sign arriving ready to sign.Open
Show us your 90-plus bucket
Send us an aged A/R summary and a month of remittance advice. We will tell you which denials were still winnable, which balances were never explained, and what the two together are costing you a quarter.