Services
Insurance Eligibility Verification Services
Many denials start at check-in: coverage that ended, the wrong payer, a secondary plan nobody recorded, or a referral that was never on file. We verify eligibility and benefits before scheduled visits, flag problems while there is still time to fix them, and give your front desk what it needs to collect the right amount.
- Electronic 270/271 checks backed by portal and phone verification
- Primary and secondary coverage order confirmed
- Copays, deductibles and coinsurance noted before the visit
7+ yearsIn medical billing and revenue cycle management
Dedicated account managerYour main contact for billing questions
Multi-specialty teamBilling and coding across many specialties
Free billing auditNo patient data needed to get started
What we verify before each visit
Active coverage
Coverage effective and termination dates checked against the date of service using the 270/271 eligibility transaction.
Plan and network
The exact plan, product type and whether your providers are in network for it, since one carrier can sell dozens of products.
Service-specific benefits
Benefits for the service being provided, such as therapy visit limits or behavioral health benefits managed by a separate company.
Coordination of benefits
Which plan pays first when a patient has more than one, including Medicare Secondary Payer situations such as working-age patients with employer coverage.
Medicare Advantage and Medicaid plan changes
Patients who moved from Original Medicare into a Medicare Advantage plan, or between Medicaid managed care plans, so the claim goes to the plan that now covers them.
Referrals and authorizations on file
HMO-style plans that require a referral, and services that need prior authorization, flagged before the patient arrives.
Official sources: eCFR: 45 CFR 162.1202 (eligibility standard) (external site), CMS: Medicare Secondary Payer (external site), eCFR: 45 CFR 149.610 (good faith estimates) (external site)
Verification timeline
Step 1: Receive the schedule
Your upcoming schedule is shared with us daily from your practice management system.
Step 2: Verify in advance
Coverage and benefits are checked ahead of each appointment. We typically verify 2 to 3 business days before the visit.
Step 3: Flag and fix
Inactive coverage, missing referrals or wrong payers are sent to your front desk with what the patient needs to bring or update.
Step 4: Catch same-day additions
Walk-ins and same-day bookings are checked on the day, before the patient is seen where possible.
Practices that gain the most
High-volume clinics
Front desks seeing many patients a day rarely have time to check more than active coverage.
Urgent care and walk-in practices
Same-day patients leave little time to fix coverage problems before the visit.
Specialties with carved-out benefits
Behavioral health, therapy and imaging benefits are often managed by a separate vendor with separate rules.
What an electronic eligibility response does and does not tell you
An electronic eligibility check is fast, but these are the items we confirm before every visit, by portal or phone when needed.
| Item | What we check | Why it matters |
|---|---|---|
| Coverage dates | That the plan is active on the date of service. | Terminated coverage is the most common eligibility denial. |
| Copay, deductible, coinsurance | The cost share for the specific service being provided. | Lets the front desk collect the right amount at check-in. |
| Network status | Whether your providers are in network for the exact plan product. | Out-of-network visits pay differently or not at all. |
| Prior authorization rules | Whether the scheduled service needs approval first. | A missing approval usually means a denial. |
| Visit limits used so far | How many covered visits remain this year. | Therapy and similar services often have annual limits. |
| Carve-out vendors | Whether another company manages the benefit. | Claims and approvals may go to that vendor instead. |
We confirm these items directly with the payer whenever the electronic response leaves them unclear.
Frequently asked questions
How far in advance should eligibility be checked?
Far enough ahead to fix problems before the visit, and again close to the date for patients whose coverage is likely to change. Checking only at check-in leaves no time to resolve a terminated plan or missing referral. Our standard is 2 to 3 business days ahead, with a recheck for same-day changes.
Our EHR already runs eligibility checks. Why add more?
Automated checks confirm coverage is active but often miss coordination of benefits, carve-outs, visit limits and referral requirements. Verification is about reading the response and acting on what it leaves out.
What is coordination of benefits?
When a patient has more than one plan, coordination of benefits rules decide which pays first. Billing the secondary plan as primary, or not knowing a second plan exists, is a common cause of denials and later recoupments.
What about patients who change plans in January?
Plan changes at the start of the year and during open enrollment are a common source of denials, so returning patients are re-verified after those dates even when the card looks the same.
Do uninsured or self-pay patients need anything?
Under the No Surprises Act, providers generally must give uninsured and self-pay patients a good faith estimate of expected charges for scheduled services. Recording self-pay status at scheduling is the trigger for that process.
Related services and specialties
Related services
Prior Authorization
Authorization requirements checked, requests submitted with clinical support, and approvals matched to claims before the service date.
Learn more about Prior AuthorizationPatient Billing
Clear statements, payment options and respectful follow-up for the balances patients owe after insurance.
Learn more about Patient Billing
Specialties
Urgent Care Billing
Walk-in E/M levels, procedures and supplies, in-house X-ray and lab, occupational medicine, S-codes and per-visit payer contracts.
Learn more about Urgent Care BillingDermatology Billing
Same-day visits and procedures, biopsy, destruction, excision and Mohs coding, cosmetic exclusions and biologic authorizations.
Learn more about Dermatology BillingOphthalmology Billing
Eye visit codes versus E/M, medical versus routine vision coverage, cataract globals and co-management, diagnostic testing rules and intravitreal drugs.
Learn more about Ophthalmology Billing
Fix denials before the visit happens
A free audit shows how many of your rejections and denials come from eligibility and registration errors.