21+
Years of Experience
500+
Practices Served
2,500,000+
Verifications Completed
Reduce Claim Denials with Precise Insurance Eligibility Verification
Verifying patient insurance eligibility is one of the most critical steps in the medical billing process. Missed or incorrect checks can lead to costly claim denials, delayed payments, and unnecessary administrative work. With our comprehensive insurance eligibility verification support, you can stay ahead by validating patients’ coverage in real-time – before they even walk through the door.
Healthcare eligibility checks can be challenging due to frequent payer policy changes, complex coverage rules, and time-consuming manual checks. Our professional team is knowledgeable about both government and commercial payer policies, and ensures fast, efficient patient eligibility verification. By improving front-end operations, billing accuracy, and cash flow, we help healthcare practices focus on delivering quality patient care.
Our insurance eligibility services are available to practices across all 50 states.
Benefits of Our Patient Insurance Eligibility Checks
- Streamlined verification workflows that save time
- Instant, real-time insurance checks for faster patient intake
- Accurate coverage validation to prevent costly claim denials
- Specialty-specific eligibility checks tailored to practice requirements
- Multi-level quality assurance process to minimize errors
- Improved point-of-service collections and reduced accounts receivable
- Enhanced patient experience with transparent cost estimates before care
- Full compliance with payer and insurance billing regulations
How Our Insurance Eligibility Verification Process Works
Our six-step process to verify patient eligibility leverages proven best practices to deliver accurate, efficient verifications.
1
Patient Information Collection
Prior Authorization Support
4
2
Insurance Coverage Verification
System Updates and Documentation
5
3
Payer Communication
Reporting and Record Management
6
1
Patient Information Collection
2
Insurance Coverage Verification
3
Payer Communication
4
Prior Authorization Support
5
System Updates and Documentation
6
Reporting and Record Management
Patient Information Collection
We gather complete and accurate patient and insurance details, including policy numbers, demographics, and appointment information.
Insurance Coverage Checks
Our team validates eligibility, plan type, coverage limits, copays, deductibles, and policy status directly with payers.
Payer Communication
When required, we contact insurance companies to confirm unclear details or resolve discrepancies in coverage information.
Prior Authorization Support
We identify procedures requiring pre-authorization and obtain approvals to prevent delays and denials.
System Updates and Documentation
All verified details are updated in your EHR or billing system, ensuring accurate, up-to-date patient records.
Reporting and Record Management
All outcomes are documented and securely maintained for audit, compliance, and future reference.
We also help you clearly explain insurance eligibility and benefits to patients so that they understand co-pays, deductibles, and coverage limits. This proactive approach boosts point-of-service collections and supports informed care decisions.
Unique Benefits of Choosing Us
Live Calls for Insurance Eligibility Verification
We go beyond automated portals by calling payers directly to confirm eligibility details. This real-time insurance eligibility verification eliminates guesswork and ensures timely and accurate billing.
Experience and Expertise
We provide patient eligibility verification for a wide range of plans including commercial health, Medicare, Medicaid, workers’ comp, dental, vision, and more. Our specialists understand the nuances of various insurance types and medical specialties.
Rapid Turnaround
Whether you need same-day verifications or urgent insurance details, our efficient team ensures fast turnaround times. That means fewer delays and more efficient patient scheduling.
Open Communication with Payers and Practices
Our team handles common payer issues, like incorrect policy info or expired plans, through proactive communication. This mitigates claim denials and streamlines the insurance verification process.
Seamless EMR Updation
We sync verified details directly into your EMR/PMS. By this process, you get to save your staff time, minimize possibilities for human error, and significantly improve compliance and revenue outcomes.
Improved Revenue Cycle
As we verify eligibility upfront, it automatically reduces rejections and payment delays. Our insurance verification services ensure better claim outcomes and faster reimbursements, directly improving your revenue cycle.
Have urgent cases? Submit a stat request through our secure portal. We will verify coverage within minutes via real-time databases or direct payer contact, enabling uninterrupted patient care.
We serve all 50 states
Flexible and Affordable Pricing Plans
Choose from our flexible pricing models based on your needs
Online Verifications
Rates as low as $2.00 per verification.
Automated real-time online verification for quick, accurate eligibility checks. Online checks are designed for high-volume needs.
Phone Call Verifications
Rates as low as $3.00 per verification.
Customized checks via phone calls, where our dedicated team of experts directly contact the patient’s insurance company for detailed coverage information.
FTE & Fixed Pricing Models
Full-Time Equivalent (FTE):
Services are billed based on the cost of a full-time resource assigned exclusively to your project for a defined period.
Services are billed based on the cost of a full-time resource assigned exclusively to your project for a defined period.
Fixed Cost Pricing:
A dedicated professional supports your practice on a consistent basis at a predetermined monthly rate.
Frequently Asked Questions (FAQs)
What is insurance eligibility verification?
Insurance eligibility verification is the process of validating a patient’s insurance policy before their appointment. It ensures the said treatment/procedure is covered, helping to reduce claim denials and improve billing accuracy.
Why is patient eligibility verification important for medical billing?
Patient eligibility verification is the first, vital step in the medical billing process. It helps verify coverage details such as policy status, co-pays, deductibles, and referral requirements; thereby ensuring proper claim submissions and faster reimbursements.
How do your insurance verification services work?
We collect patient insurance details, verify coverage via portals and live calls, update your EMR or PMS, and promptly notify your team of any issues. Our established, diligent process includes routine verifications and urgent (stat) checks when required.
What are the benefits of choosing your company for insurance verification?
By collaborating with us, you can improve your revenue cycle while focusing on patient care. We reduce administrative burdens, minimize claim rework, and ensure accurate verifications your faster turnaround times.
Can you handle verifications for different insurance types and providers?
Yes. We provide insurance verification services for all major private and government payers, including Medicare, Medicaid, workers’ comp, regional insurers and specialty plans like dental, vision, and behavioral health.
What happens if a patient’s insurance can’t be verified before their appointment?
If coverage cannot be verified, we will immediately notify your team. We also assist in contacting the patient or payer to resolve the issue quickly, helping you decide whether to reschedule, collect payment upfront, or proceed with caution.
Do you support EMR or PMS integration for insurance verification?
Yes. We work directly within your software systems to update verified insurance data in real time. This seamless integration reduces manual entry errors and speeds up the billing process.
How long does the insurance eligibility verification process take?
Standard verifications are usually completed within 24 hours or less. However, stat requests are processed immediately, providing real-time results so your team can do instant scheduling or make treatment decisions.
What are the best practices for insurance verification in a medical practice?
Some of the best practices include verifying coverage at least 48 hours before the appointment, confirming all plan details (deductibles, co-pays, network status), updating your PMS/EMR promptly, and proactively communicating coverage info to patients.
Can I request urgent (stat) insurance verifications?
Yes. We offer a dedicated stat verification service for urgent cases. Just submit your request through our portal, and our team will verify and return coverage details in real time.
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