Standard verification stops at "is this patient covered." The ADPE Agent goes one layer deeper — auditing procedure-level frequency limits before the patient ever sits in the chair.
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"Active insurance" only tells the front desk the patient has a policy — not whether this specific procedure is billable today.
Frequency limits, and patients seeking the same care across multiple FQHC sites, are where claims quietly fail. By the time the denial comes back, the visit has already happened and the revenue is gone.
The ADPE Agent automatically audits historical claim limits for each procedure, shifting front desk's job from "check if covered" to "confirm this exact treatment is billable, today, for this patient." Complex or borderline cases are still flagged for staff to make final call.
| Procedure | Frequency Window | Status |
|---|---|---|
| Dental Cleaning | Every 6 months | Available Now |
| Bitewing X-rays | Every 6 months | Available Now |
| Panoramic X-rays | Every 3 years | Available Now |
Support for additional clinical codes is on the product roadmap.
Checks procedure-specific histories automatically before the patient arrives — no manual lookup required.
Passes complex cases or likely denials to clinic staff with full context, so a person makes the final call.
Proactively books the next visit only once the patient's eligibility window officially reopens.
Catch frequency-limit violations and multi-site clinic hopping before services are rendered — not after the claim bounces back.
Automate the repetitive insurance inquiries, freeing your front desk to focus on patient care instead of claim archaeology.
Support organization-wide financial viability with appointments that are pre-approved, not just pre-scheduled.
