Eligibility & Benefits Verification
The cheapest denial is the one that never happens. Verify everything before the visit.
Overview
Eligibility errors are the single most common — and most preventable — cause of claim denials. A terminated plan, an out-of-network product, an unmet deductible nobody mentioned: each one becomes either a denied claim or an awkward patient balance conversation.
We verify every scheduled patient 24–72 hours before their visit: active coverage, plan type, copay, coinsurance, remaining deductible, referral requirements, and service-specific benefit limits. Your front desk starts each day with a clean, flagged worklist instead of surprises.
What's Included
Pre-Visit Verification
Every appointment verified 1–3 days ahead through payer portals and clearinghouse checks.
Patient Cost Estimates
Copay, coinsurance, and deductible status calculated so patients can pay at check-in.
Benefit-Level Detail
Service-specific limits — visit caps, therapy thresholds, DME rules — checked, not just 'active/inactive'.
Same-Day Add-On Coverage
Walk-ins and same-day additions verified in real time.
Issue Flagging
Terminated plans, coordination-of-benefits issues, and out-of-network alerts raised before the visit.
Recheck at Claim Time
High-risk plans re-verified at submission to catch mid-month coverage changes.
Frequently Asked Questions
By check-in it's too late to fix problems — the patient is standing in front of you. Verifying 1–3 days ahead gives time to update coverage, obtain referrals, reschedule, or set payment expectations.
Yes. Beyond active coverage, we confirm service-level benefits: therapy visit limits, imaging pre-cert rules, behavioral health carve-outs, DME coverage, and anything else your specialty depends on.
However your workflow prefers: directly into your PM/EHR eligibility fields, a daily flagged worksheet, or both. Problem cases are highlighted with the exact action needed.