Know Before You See — Eliminate Surprises, Rejections, and Revenue Loss at the Source
Every unverified patient is a financial risk. A lapsed policy, an out-of-network provider, an unmet deductible — each one becomes a denied claim or uncollectable patient balance. Our verification team eliminates these risks completely.
What We Do
We verify patient insurance eligibility in real time using direct payer connections, clearinghouse queries (Availity, Change Healthcare, Waystar), and payer portals. Verification is completed 24–72 hours before every scheduled appointment, giving your team time to address any issues before the patient arrives.
We don't just confirm "active" — we extract the complete benefits picture. This includes plan type (HMO, PPO, EPO, POS, HDHP), effective and termination dates, deductible amounts (individual and family — amount met and remaining), out-of-pocket maximum, copay amounts by service type, coinsurance percentages, in-network vs out-of-network status, and any visit limitations.
When a patient carries multiple insurance policies, COB sequencing must be determined before billing. Billing the wrong payer first results in payment delays and compliance issues. We identify primary, secondary, and tertiary payers and document COB correctly in your PMS.
Our eligibility team flags any prior authorization requirement identified during verification and initiates the authorization workflow. For Medicare and Medicaid, we handle ABN requirements, spend-down tracking, dual eligibility coordination, and state-specific managed care plan verification.
The verification data we collect feeds directly into your financial counseling workflow. Knowing exactly what a patient owes before they arrive allows your front desk to collect estimated patient portions at time of service — dramatically improving point-of-service collections.
What's Included
Real-Time Verification
Direct payer connections and clearinghouse queries
Complete Benefits Extraction
Deductibles, copays, coinsurance, limitations
Coordination of Benefits
Primary/secondary/tertiary sequencing
Prior Auth Identification
Flags PA requirements during verification
Medicare/Medicaid Verification
Government payer specialized knowledge
Financial Counseling Data
Patient responsibility estimation
Why This Matters for Your Revenue
Frequently Asked Questions
We verify 24-72 hours before each scheduled appointment, giving adequate time to resolve any issues with coverage, authorization, or patient responsibility.
Our team makes direct phone calls to payer provider services lines to obtain verification manually, documenting all details including reference numbers.
We identify PA requirements during verification and can initiate the authorization workflow. Full prior authorization management is also available as a complementary service.
For urgent or same-day appointments, we prioritize verification and complete it within 1-2 hours of scheduling, alerting your team to any issues immediately.
Yes, we verify for all commercial payers, Medicare, Medicaid (all states), Tricare, workers compensation, and auto accident cases.
We verify coverage through the employer or insurance carrier, confirm claim numbers, and document authorization requirements specific to injury cases.