Check Before Care
Review eligibility, benefits, planned treatment, authorization requirements, expiration dates, and remaining visits or units.
PRIOR AUTHORIZATION & PATIENT ACCESS
Protect the appointment.
Protect the revenue.
AI-powered prior authorization and benefits verification that connect the schedule, clinical record, and payer requirements, so your team can keep treatment moving.
PREVENT THE DOWNSTREAM PROBLEM
A change in treatment.
Not a surprise at billing.
See how an updated plan changes authorization and billing work before it becomes a denial.
See Our Neurology PA Results ↗SEE WHY CONNECTED WORK MATTERS
Example 1 of 4
The doctor changes the treatment.
Updated treatment plan
6 units8 units
The existing authorization still covers 6 units.
SILOED RCM
Billing misses the change.
- 1Chart updated.
The doctor records 8 units.
- 2Approval unchanged.
Billing still works from 6 units.
- 3Mismatch reaches the payer.
A potential denial triggers rework.
Find it late. Chase it afterward.
The Kairos Edge
Catch the mismatch before filing.
- 1Connect the records.
Compare the 8-unit plan with the 6-unit approval.
- 2Flag before submission.
Route the mismatch with evidence for resolution.
- 3Carry the fix forward.
Billing uses the resolved record and approval.
Catch it early. Resolve it before filing.
Shared Context
A clinical change informs authorization, billing, and payment review, not just the chart.
The patient has a new insurance plan.
Updated insurance coverage
Plan APlan B
The authorization on file is for Plan A.
SILOED RCM
The old plan carries through.
- 1New card recorded.
Registration updates the plan.
- 2Old approval reused.
New payer requirements go unchecked.
- 3Coverage problem surfaces.
The claim is rejected or denied.
Discover the coverage gap after the claim.
The Kairos Edge
Align coverage before care.
- 1Connect coverage to care.
Check Plan B against treatment and the approval.
- 2Recheck requirements.
Identify new benefits or authorization work.
- 3Update the whole account.
Billing gets the current plan and approval.
Align coverage, authorization, and billing first.
Shared Context
One insurance update reaches benefits, authorization, and billing together.
The appointment gets rescheduled.
New treatment date
June 20July 8
The authorization is valid only through June 30.
SILOED RCM
The approval expires unnoticed.
- 1Appointment moved.
Scheduling records July 8.
- 2Expiry overlooked.
The approval ends June 30.
- 3Problem found after care.
The payer may deny the claim.
A calendar change becomes a payment problem.
The Kairos Edge
Resolve the gap before the visit.
- 1Compare dates.
Check July 8 against the June 30 approval expiry.
- 2Alert before treatment.
Route the date gap for resolution with the payer.
- 3Keep every step aligned.
Scheduling and billing use the updated approval.
Resolve the approval gap before the visit.
Shared Context
A schedule change triggers an approval check before it becomes a billing problem.
The payer sends a payment.
Contract rate vs. payment
$1,000 owed$850 paid
A $150 difference needs to be explained.
SILOED RCM
Paid gets treated as finished.
- 1Payment posted.
$850 is recorded as received.
- 2Contract left out.
Nobody compares the reimbursement terms.
- 3Gap goes unworked.
A possible $150 underpayment is missed.
Money received. Missing money overlooked.
The Kairos Edge
Find the gap. Own the follow-up.
- 1Compare payment and terms.
Check $850 against the expected $1,000.
- 2Validate the $150 gap.
Rule out valid adjustments and patient responsibility.
- 3Own the recovery.
Pursue confirmed underpayments and reconcile receipts.
Verify what is owed. Pursue the real gap.
Shared Context
Contracts, claims, and payments stay connected until the difference is explained.
THE SCOPE, MADE EXPLICIT
What leaves your desk.
What we carry through.
Prepare And Follow Through
Gather chart evidence, prepare payer-specific requests, submit through supported channels, and track responses with specialist follow-up.
Keep Treatment And Billing Aligned
Track approvals and renewals. Route the precise missing item or clinical decision to your team; carry the resolved record into billing.
We confirm systems, payer coverage, responsibilities, and review requirements before starting. Clinical decisions and necessary approvals remain with your practice.
BEFORE YOU DECIDE
Know what you're getting.
Is prior authorization included in your RCM service?
Yes. Prior authorization is an explicit part of the full-cycle service, and it is also available as a defined engagement. We agree responsibility for PA, claims, and follow-up before starting.
Can we keep our current biller?
Yes. We can begin with patient access and prior authorization while your team or vendor keeps billing. The handoff includes the information billing needs, and ownership of each task is agreed upfront.
Does an approved authorization guarantee payment?
No. Payment still depends on coverage, the service delivered, coding, claim requirements, and the applicable contract. That is why we connect the authorization to the rest of the revenue cycle.
What would we measure first?
We establish a baseline for manual work, authorization turnaround, first-pass PA decisions, and treatment readiness. PA denials and claim denials are measured separately.
LET'S FIND THE OPPORTUNITY
Your next point of margin is already in your practice.
Let's find where it's getting lost, and put a team to work on it.