02 — Capability · BC-1810
Patient Access
Get each patient to the right appointment or admission with a confirmed identity, verified coverage, any authorization the payer requires and a clear view of what they will owe, so care starts on time and the claim can be paid. Delivering the care and billing for it afterward are owned elsewhere.
- Front-End Revenue Cycle
- Patient Access Services
- Patient Intake
- Front Office
In scope
- Referral intake, appointment scheduling and provider schedule templates
- Registration, check-in, patient identity resolution and consent capture
- Eligibility and benefits verification and provider-side prior authorization
- Patient cost estimates, financial clearance and point-of-service collections
Out of scope
- General contact center handling of patient calls and messages (see BC-450.20)
- The payer's own review and decision on an authorization request (see BC-1870.50)
- Bed assignment, transfers and discharge events after admission (see BC-1820.50)
- Billing and collecting patient balances after the visit (see BC-1840.50)
Realized by · 11
- Salesforce · Health Cloudpartial via BC-1810.10.10
- Epic · Patient Accesscore via BC-1810.10.30
- Epic · Care Everywhere and Interoperabilitycore via BC-1810.10.20
- Epic · Payer-Provider Exchangepartial via BC-1810.40.20
- Oracle Health · Patient Administrationcore via BC-1810.10.30
- Oracle Health · Interoperability, Referrals and Public Health Reportingstrong via BC-1810.10.20
- Oracle Health · Oracle Health Paymentpartial via BC-1810.50.30
- MEDITECH Expanse · Revenue Cyclecore via BC-1810.30.10
- MEDITECH Expanse · Electronic Prior Authorizationpartial via BC-1810.40.10
- MEDITECH Expanse · Patient Connect and Patient Portalstrong via BC-1810.10.30
- InterSystems HealthShare · Patient Indexcore via BC-1810.20.30
Used in · 9
- Referral-to-Appointment · 01 Receive Request via BC-1810.10
- Referral-to-Appointment · 02 Register Patient via BC-1810.20
- Referral-to-Appointment · 03 Schedule via BC-1810.10
- Referral-to-Appointment · 04 Verify Coverage via BC-1810.30
- Referral-to-Appointment · 05 Authorize via BC-1810.40
- Referral-to-Appointment · 06 Estimate & Clear via BC-1810.50
- Admit-to-Discharge · 01 Admit via BC-1810.20
- Order-to-Result · 02 Schedule & Collect via BC-1810.10
- Encounter-to-Cash · 06 Bill & Collect from Patient via BC-1810.50
Build it · 3
- technology Electronic Health Record Systems via BC-1810.10
- technology Health Data Interoperability Engines via BC-1810.20.30
- technology Healthcare Claims Clearinghouses & Billing Systems via BC-1810.30
Decomposes into · 5
- BC-1810.10Patient Scheduling & ReferralsTurn every referral and appointment request into a booked slot with the right provider, place and preparation, and keep provider schedules full without overbooking. Booking an operating room case is surgical services.
- BC-1810.20Patient Registration & IdentityRegister every patient once, under one correct identity, with current demographics, coverage and consents, so every record, order and claim lands on the right person. Correcting information already in the legal health record is health information management.
- BC-1810.30Eligibility & Benefits VerificationKnow before the visit whether the patient is covered, by whom, in what order and for which services, so the right payer is billed and coverage surprises are found while they can still be fixed. Deciding a member's eligibility is the health plan's own capability.
- BC-1810.40Prior AuthorizationObtain the payer approvals a planned service requires before it is performed, as the provider requesting them, and keep the service, the approval and the claim in step. Reviewing and deciding the request is the health plan's utilization management.
- BC-1810.50Patient Financial CounselingTell patients before care what they are likely to owe and how they can pay or get help, and clear each account financially before scheduled services. Statements, payment plans and collections after the visit are patient billing.