Your billers are paid to work claims.
They spend their day on hold.
HoldForYou queues the payer call, works through the phone tree, sits out the hold, and talks to the representative. What comes back is a filled-in claim status with the denial code, the check number and the call reference number, waiting in a queue. No biller listened to any of it.
Built for two-person billing shops and mid-size RCM teams — the buyers enterprise vendors cannot serve at enterprise prices. Not HIPAA-certified. Here is exactly what it is not.
The problem is not the call. It is the wait before the call.
Hold time is payroll
A biller on hold is fully paid and producing nothing. It is the one line item in an RCM operation where cost accrues at exactly the same rate as work, and nobody can tell the difference from the outside.
Portals send you to the phone anyway
A portal shows a status code. It rarely shows why the claim denied, which procedure it was bundled into, when the check went out, or how long you have to appeal. Those answers live with a representative. Why that happens.
The work is repetitive, not hard
Authenticate with NPI and tax ID, read out the member ID and date of service, ask the same six questions, write down the answers, get the reference number. It is a script. Scripts are the thing worth automating.
Three steps
Queue the call
Pick the payer line and the playbook — claim status, eligibility, or prior authorization — and hand over the claim details. That is the whole biller interaction. It takes about as long as filling in a search form.
The agent dials, holds, and talks
HoldForYou navigates the IVR, waits in the normal queue for as long as it takes, detects when a live representative picks up, and conducts the conversation itself. It states it is an automated assistant before anything else.
A structured result lands in your queue
Fields, not a recording. A biller reviews a filled-in form instead of making a call. Anything the agent is not confident about is flagged for review rather than quietly written down as fact.
The agent may only state facts you gave it
The playbook is a hard contract: the model can repeat the provider and patient details supplied with the job and nothing else. A model that invents a member ID on a live payer call is worse than no automation, so the prompt, the output schema and a separate validator each enforce that independently. A result that fails validation does not reach your queue as a finished answer.
What comes back
These are the actual fields in the claim status playbook. Two are required — the call cannot be marked complete without them.
| Field | Type | Required |
|---|---|---|
| Claim status paid, denied, pending, in process, rejected, not on file, appealed, reversed | one of eight values | required |
| Date of that status | date | |
| Amount paid | money | |
| Allowed amount | money | |
| Patient responsibility | money | |
| Check or EFT number | text | |
| Check or EFT date | date | |
| Denial reason, in the rep's own words | text | |
| Denial / CARC code | text | |
| What the rep says must happen next | text | |
| Appeal deadline | date | |
| Call reference number | text | required |
The call reference number is required on every playbook, not just this one. It is the proof the call happened, and the agent is instructed to ask for it before ending the call. Why it matters.
Eligibility and benefits
Coverage active on the date of service (required), plan name, effective and termination dates, copay, coinsurance, deductible and deductible met, out-of-pocket maximum and met, whether prior authorization is required, whether this plan is primary, and the call reference number.
Prior authorization status
Authorization status (required) — approved, denied, pending, not required, not on file, or more information needed — plus the authorization number, valid-from and valid-to dates, units or visits approved, denial reason, what must happen next, and the call reference number.
Results are readable in the queue and exportable as CSV, which is the format most billing teams already ingest.
What this is not
The honest list. If any of these are dealbreakers, you should know now rather than three weeks into a pilot.
Not HIPAA-certified
HoldForYou does not hold HIPAA certification or SOC 2 Type 2. As it stands it is designed not to touch protected health information, and it must not be used with PHI in its current state.
What it would take: signed business associate agreements with the telephony and speech-to-text vendors, encryption at rest, access control, audit logging and a retention policy. The audit table already exists. SOC 2 Type 2 is a separate, longer exercise with an observation window and a real audit bill.
No EHR or PM write-back
Nothing is written into your practice management system. Results live in the HoldForYou queue and come out as CSV.
Every practice management system is its own integration, and that work is a grind nobody finishes quickly. We would rather say so than imply an integration that does not exist.
Not fully autonomous
When the agent cannot finish — the representative asks something outside the playbook, the call runs past its turn limit, or the answer is not converging — it escalates.
It tells the representative a colleague is joining and pulls a person from your team onto the same live call. The hold is still gone. Only the last stretch of conversation comes back to a human.
What is hold time costing you?
This calculator has no benchmark in it and no industry average. Every number below is one you type. The arithmetic is printed on screen so you can check it against your own payroll rather than trust a slider.
Your numbers
These defaults are placeholders, not a claim. Ten billers, eight hours and $25 an hour are round numbers used to make the arithmetic legible. Replace all three with your own before you show this to anyone.
Annual cost of waiting
The arithmetic
Per-call comparison
The same call, costed two ways. A biller's time is charged at the loaded rate you entered above. The machine side is telephony and speech-to-text metered by the minute.
| One call | Basis | Cost |
|---|
Questions
Is this HIPAA compliant?
No. HoldForYou is not HIPAA-certified and does not hold SOC 2 Type 2, and it must not be used with PHI as it stands. Getting to a HIPAA posture means business associate agreements with the telephony and speech-to-text vendors, encryption at rest, access control, audit logging and a retention policy. The audit table is already in the build; the rest is real work with a real timeline. We would rather tell you that than sell you a badge we do not have.
Does it write back into our PM system?
No. Results stay in the HoldForYou queue and export as CSV. There is no practice management or EHR integration today and we are not going to imply one.
What happens when the agent gets stuck?
It escalates onto the same call. The agent tells the representative a colleague is joining, and HoldForYou rings a person on your team into the live call. You lose the automation on that call; you do not lose the hold time, which was the expensive part.
How do we know the agent did not make something up?
Three separate mechanisms. The agent may only state facts supplied with the job. Every extracted result carries a confidence score, and the model is told to score itself harshly if it inferred anything. A validator then checks that the required fields are actually filled. Anything that fails is marked "needs review" and a person confirms or corrects it before it counts.
Which payer lines can it call?
The ones you load from your own payer grid. Provider-services numbers differ by state, plan and product line and are printed on the back of each member ID card, so there is no national number that is right for every claim. Nothing ships pre-loaded on purpose.
Does the representative know they are talking to software?
Yes, by default. The disclosure is the first sentence of the call, before the agent asks for anything.
What does it cost?
It is priced per seat, and we quote against your own numbers rather than publishing a table that would be wrong for most teams. Run the calculator first, then talk to us. If the annual figure it produces is small, you should not buy this.
Bring us your own number
Tell us how many billers you have, how much of their week goes to hold, and which payers are the worst offenders. If the arithmetic does not justify it, we will say so.
Email usPrefer to read first? Start with the answers library — plain explanations of the questions billers call payers about.