Overview
Applications at each stage
Every application waits for two things: its documents and the Explanation of Benefits (EOB).
- 0Waiting for documents
- 0Pending EOB
- 0In review
- 0Approved
- 0Not approved
Deadlines, documents and totals are not shown to this role.
In the real workspace: the application opens on the desk’s tablet for the patient to fill in, or the patient gets the link on their own phone.
Decision due
The decision is due seven days after the EOB arrives. If documents are still missing on that day, the seven days start when the file is complete: until then no deadline runs. The nearest deadlines come first.
| Reference | Patient | Emergency room | In review since | Decision due | Days left |
|---|
Waiting longest for documents
| Reference | Patient | Emergency room | Applied on | Waiting for | Still needed |
|---|
The last 30 days
- Applications received
- Decisions made
- Approved
- Discounts given
- $4,134.18
- In review before the decision, on average
Applications
In the real workspace: the application opens on the desk’s tablet for the patient to fill in, or the patient gets the link on their own phone.
In the real workspace: you choose the patient’s application and note that they asked at the front desk. The request goes to the billing team’s list of payment plans, and the patient gets a text message.
| Reference | Patient | Date of service | Emergency room | Household size | Yearly income | Estimated tier | Stage | Days left | Assigned to |
|---|
No application matches these filters.
Income, tier, deadline and the person assigned are not shown to this role.
Application
- Stage
- Decision due
- Estimated tier
- Assigned to
Application received
Documents
Explanation of Benefits (EOB)
Review
Decision
The application, as the patient sent it
Basic Information
- Patient's Full Name
- Who is filling this in?
- Account #
- Date of service
- Best Phone Number for Contact
- Email Address
Not in your form. Asked in our sample of the application:
- Date of birth
- Emergency room
- Billed to commercial health insurance
- Relationship of the person applying
Financial and Hardship statement
- Total Household Size
- Annual Household Gross Income
- Current Employment Status
- Is there anything you would like to share with our team regarding your current financial journey?
Documentation & Verification
In the real workspace: the document opens here, beside the application.
- Proof of Texas Residency
- Final Attestation & Electronic Signature
Not in your form. Asked in our sample of the application:
- Photo ID
This role sees the first section and the stage. Income, the hardship statement, the documents, the tier and the decision are not shown.
EOB
Every application waits for it. Your team gets it from the insurer and records it here.
Not recorded yet.
- Arrived on
- Patient’s share after insurance
- Recorded by
Tier and discount
- Household size and yearly income
- Tier, from the discount table
- Income range of this tier
- Discount of this tier
- Patient’s share after insurance
- Discount, %
Decision
Actions
In the real workspace: you choose the missing document, the patient gets a text message with a link to add it, and the request shows in the timeline.
In the real workspace: you enter the day the EOB arrived and the patient’s share. The discount in dollars is worked out. The seven days start, or wait until the file is complete if documents are still missing.
In the real workspace: you confirm the tier or correct it and add a reason. The application then waits for the program manager.
In the real workspace: the approval is recorded under your name, the patient is told, and their status page shows the new amount.
In the real workspace: you choose a reason, the patient is told, and their status page shows the reason and how to ask for a 0% interest payment plan.
Only a program manager approves or declines.
Internal notes
For the team. The patient does not see them.
No notes yet.
Timeline
Who did what, the newest first.
| When | Who | What |
|---|
What the patient has been told
Sample: the patient follows the same application step by step on their own status page. See the patient’s side of this (sample) (opens in a new tab)
Payment plans
Requests for a 0% interest payment plan, made by phone or at the front desk.
In the real workspace: you choose the patient’s application and note how they asked, by phone or at the front desk. The request appears in this list, and the patient gets a text message.
| Patient | Reference | Asked on | How the patient asked | Decision | Left to pay | State |
|---|
Reports
The last six months, all emergency rooms.
Sample: every number on this screen is made up.
Applications per month
| Month | Applications received | Decided | Approved | Share approved |
|---|---|---|---|---|
| 14 | 12 | 86% | ||
| 19 | 17 | 89% | ||
| 23 | 20 | 87% | ||
| 21 | 18 | 86% | ||
| 20 | 18 | 90% | ||
| 4 | 3 | 75% | ||
| Six months | 101 | 88 | 87% |
Discounts given per tier
Approved applications of the last six months.
| Tier | Discount | Approved | Discounts given |
|---|---|---|---|
| Tier 1 (≤300% FPL) | 100% | 31 | |
| Tier 2 (301%–500% FPL) | 80% | 27 | |
| Tier 3 (501%–700% FPL) | 60% | 18 | |
| Tier 4 (701%–900% FPL) | 40% | 12 | |
| All tiers | 88 |
Days in review before the decision
99 of 101 decisions were made within seven days. The seven days count from the day the Explanation of Benefits (EOB) arrives, or from the day the file is complete if that is later.
| Time to the decision | Decisions |
|---|---|
| 1 to 2 days | |
| 3 to 4 days | |
| 5 to 6 days | |
| 7 days | |
| More than 7 days |
Per emergency room
The last six months.
| Emergency room | Applications received | Approved | Discounts given |
|---|---|---|---|
| Arlington | 10 | $14,853 | |
| Arlington-Mansfield | 7 | $10,283 | |
| Benbrook | 5 | $6,855 | |
| Carrollton | 9 | $12,568 | |
| Cedar Hill | 6 | $9,141 | |
| Denton | 9 | $13,711 | |
| DeSoto | 7 | $10,283 | |
| Fort Worth | 11 | $15,996 | |
| Frisco | 8 | $11,426 | |
| Garland | 5 | $7,998 | |
| Garland/Sachse | 7 | $10,283 | |
| Weatherford | 4 | $5,713 | |
| All emergency rooms | 88 | $129,110 |
Discount table
The table every tier and every discount in this workspace is worked out from.
Tiers and discounts
The discount is taken off the patient’s share after insurance.
| Tier | Share of the poverty level (FPL) | Discount |
|---|---|---|
| Tier 1 | ≤300% FPL | 100% |
| Tier 2 | 301%–500% FPL | 80% |
| Tier 3 | 501%–700% FPL | 60% |
| Tier 4 | 701%–900% FPL | 40% |
| Tier 5 | >900% FPL | No discount |
Yearly income limits by household size, 2026
| Household size | Poverty level (100%) | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
|---|---|---|---|---|---|---|
| 1 | $15,960 | $0 – $47,880 | $47,881 – $79,800 | $79,801 – $111,720 | $111,721 – $143,640 | Over $143,640 |
| 2 | $21,640 | $0 – $64,920 | $64,921 – $108,200 | $108,201 – $151,480 | $151,481 – $194,760 | Over $194,760 |
| 3 | $27,320 | $0 – $81,960 | $81,961 – $136,600 | $136,601 – $191,240 | $191,241 – $245,880 | Over $245,880 |
| 4 | $33,000 | $0 – $99,000 | $99,001 – $165,000 | $165,001 – $231,000 | $231,001 – $297,000 | Over $297,000 |
| 5 | $38,680 | $0 – $116,040 | $116,041 – $193,400 | $193,401 – $270,760 | $270,761 – $348,120 | Over $348,120 |
| 6 | $44,360 | $0 – $133,080 | $133,081 – $221,800 | $221,801 – $310,520 | $310,521 – $399,240 | Over $399,240 |
| 7 | $50,040 | $0 – $150,120 | $150,121 – $250,200 | $250,201 – $350,280 | $350,281 – $450,360 | Over $450,360 |
| 8 | $55,720 | $0 – $167,160 | $167,161 – $278,600 | $278,601 – $390,040 | $390,041 – $501,480 | Over $501,480 |
| Each additional person | +$5,680 | +$17,040 | +$28,400 | +$39,760 | +$51,120 | Over the Tier 4 limit |
Changing the table
The discounts may change after a review by management. The program manager changes them here, in one place, and the tier of every later decision follows.
In the real workspace: you enter the new percentage or the new yearly figures. The change applies to decisions made after it and is written to the activity log.
This role can read the table. Only a program manager can change it.
Team and roles
Who is on the team, and what each role may see and do.
People
| Name | Role | Emergency room |
|---|---|---|
| Avery Specimen | Front desk | Arlington |
| Quinn Testcase | Front desk | Carrollton |
| Dana Example | Billing specialist | All emergency rooms |
| Lee Mockup | Billing specialist | All emergency rooms |
| Morgan Demo | Program manager | All emergency rooms |
| Taylor Placeholder | Administrator | All emergency rooms |
In the real workspace: you enter the person’s name and work email address and choose a role. They can sign in from then on.
In the real workspace: you choose a person and a new role. The change takes effect at once and is written to the activity log.
This role can read the list. Only the administrator adds people and sets roles.
What each role may see and do
| In the workspace | Front desk | Billing specialist | Program manager | Administrator |
|---|---|---|---|---|
| See the overview | Own emergency room | Yes | Yes | Counts only |
| See the list of applications | Own emergency room | Yes | Yes | No |
| Start an application with a patient | Yes | No | No | No |
| See name, contact details and date of service | Own emergency room | Yes | Yes | No |
| See income, hardship statement and documents | No | Yes | Yes | No |
| See the Explanation of Benefits (EOB), the tier, the discount and the deadline | No | Yes | Yes | No |
| Ask for a document, record the EOB, propose a decision | No | Yes | Yes | No |
| Approve or decline | No | No | Yes | No |
| Read and write internal notes | No | Yes | Yes | No |
| See requests for a payment plan | No | Yes | Yes | No |
| Record a request for a payment plan | Own emergency room | Yes | Yes | No |
| Read the reports | No | No | Yes | No |
| See the discount table | No | Yes | Yes | No |
| Change the discount table | No | No | Yes | No |
| See the team and the roles | No | No | Yes | Yes |
| Add people and set roles | No | No | No | Yes |
| Read the activity log | No | No | Yes | Yes |
Activity log
Who opened or changed which application, the newest first.
| When | Who | Role | What | Application |
|---|