Threshold
No More “We’ll Bill You And You’ll See”
Threshold reads the payer's eligibility and benefits response, combines it with your contracted rates and the planned service, and produces an estimate of patient responsibility your front desk can actually explain.
Payer responses are not written to be understood
An eligibility response is a dense, abbreviated document written for systems rather than for people. Asking a front-desk coordinator to translate it into “what will this cost me” in real time, with a patient waiting, is not a reasonable request.
Threshold processes the eligibility and benefits information, converts the payer response into a usable summary, and combines benefits, contracted rates and the expected service into an estimate of what the patient is likely to owe.
The estimate comes with a plain-language explanation, and where a balance warrants it the system can identify payment-plan options that sit inside your own business rules rather than inventing terms.
Capabilities
What's included
Tell the patient what it costs before you treat them
Payer responses made readable
Eligibility and benefits output is converted into a summary a human can act on during a conversation.
Estimates from your real rates
Contracted rates and the planned service drive the estimate, not a list price nobody pays.
Plain-language explanation
The estimate comes with language staff can read out, which is what turns a number into an understood number.
Payment options inside your rules
Payment-plan options are identified within the business rules you define, rather than improvised at the desk.
Why it matters
The outcomes practices actually measure
We are evaluated on the numbers that change in your operation, not on features shipped or tickets closed.
- Fewer financial surprises
- The complaint behind most billing disputes is not the amount. It is that nobody mentioned it beforehand.
- Staff who can answer the question
- Front-desk and patient access teams get an answer they can give immediately rather than a promise to find out.
- Better point-of-service collection
- Money discussed before the service is collected far more reliably than money discussed in a statement six weeks later.
- Clearer information for patients
- Patients get a figure and an explanation, which is the minimum a healthcare interaction should include.
How it works
What working with us looks like
- 1
Pull eligibility and benefits
The system processes the payer's eligibility and benefits response for the patient and plan.
- 2
Translate the response
The payer's response is converted into a usable summary rather than a screen of abbreviations.
- 3
Estimate responsibility
Benefits, contracted rates and the expected service are combined into an estimate of what the patient is likely to owe.
- 4
Explain and offer options
Staff explain the estimate in plain language, and suitable payment-plan options are identified within your business rules.
Frequently paired with
FAQ
Threshold, frequently asked questions questions
- Is the estimate a guarantee?
- No, and it is presented as an estimate. It is built from the payer's benefits response, your contracted rates and the expected service. Final responsibility depends on how the payer actually adjudicates the claim.
- What does it need to work?
- Eligibility verification, current fee schedules, patient statement capability and reliable benefit information from the payer.
- Who uses it?
- Front-desk staff, patient access teams and financial counsellors, and indirectly the patient, who receives the explanation.
- Does it set up payment plans automatically?
- It identifies suitable options within the business rules you define. Staff confirm and set up the plan.
We're here to help
Ready to see what your revenue cycle could be doing?
Start wherever makes sense: a demo, a free assessment, or a straight conversation with someone who does this every day.