Convert More Referrals Into Arrivals

Patient access automation uses software — often combining rules-based automation with AI — to handle the front-end administrative work of getting a patient into care: scheduling, registration, insurance eligibility verification, and financial clearance. Instead of staff manually calling payers or re-keying data across systems, automated tools check coverage, flag errors, and route exceptions to staff only when human judgment is actually needed.

According to the CAQH Index, manual eligibility verification takes an average of about 16 minutes per transaction, compared to roughly 4 minutes electronically — a savings of about 12 minutes per transaction. Across the U.S. healthcare system, CAQH estimates this represents an $11.5 billion cost-savings opportunity if eligibility verification were more broadly automated.

Yes — a large share of claim denials originate at registration and eligibility, from issues like transposed policy numbers, lapsed coverage, or missing prior authorization. Automated verification and registration-error checks catch many of these problems before the claim is ever submitted. Automation does not eliminate denials entirely, but it removes a substantial, well-documented source of preventable ones.

Common registration errors include transposed policy or member ID numbers, mismatched demographic data, and outdated insurance information — small mistakes that cascade into claim denials and rework once they reach billing. Automated registration tools validate data against payer systems at the point of entry and flag inconsistencies immediately, catching errors before they propagate downstream rather than after a claim bounces back.

The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) requires certain health plans — including Medicare Advantage organizations, Medicaid and CHIP programs, and Qualified Health Plan issuers on the federally-facilitated exchanges — to make patients' claims, encounter, and clinical data available electronically through a standardized, FHIR-based API. Payers began reporting compliance metrics in 2026, covering calendar year 2025 data.

Using the CAQH benchmark of roughly 12 minutes saved per transaction (16 minutes manual vs. 4 minutes electronic) and a loaded labor cost of around $30/hour, an organization running 2,000 eligibility checks a month can free up approximately 4,800 staff hours a year — worth around $144,000 in reallocated labor capacity — before accounting for reduced claim denials. Actual ROI depends on current check volume, existing automation level, and platform cost.