Coverage failures found after the encounter are the most expensive kind, because the service is already delivered. Most of them were visible beforehand — an inactive plan, a met visit limit, an authorization nobody requested.
You know what a visit is covered for before it happens, and the patient hears an accurate number rather than a hopeful one.
At a glance
Step 1
Run electronic eligibility ahead of the visit
Step 2
Perform full benefits investigation where the detail matters — deductible, coinsurance, limits, authorization requirements
Step 3
Call the payer when the portal will not answer the question
Step 4
Identify secondary coverage the patient did not mention
What we actually do
- Run electronic eligibility ahead of the visit
- Perform full benefits investigation where the detail matters — deductible, coinsurance, limits, authorization requirements
- Call the payer when the portal will not answer the question
- Identify secondary coverage the patient did not mention
What this fixes
- Coverage confirmed weeks earlier and assumed still true
- Estimates given to patients from an eligibility check that never included benefits
- Secondary coverage discovered only after the balance became patient responsibility
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at how this runs today and where it leaks.
Scope
A written scope and price before any work starts.
Transition
We take it over without a gap in submission.
Report
The same six numbers every month, so you can see it working.
Eligibility & Benefits Verification — Frequently Asked Questions
Is an eligibility check the same as a benefits verification?
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No, and the difference is the whole point. One confirms coverage is active; the other establishes what it actually pays for. They are priced separately because they are different work.
How often should Medicaid eligibility be checked?
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Every visit. Medicaid coverage churns month to month in a way commercial coverage does not.
How is eligibility & benefits verification priced?
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It is included in ongoing revenue cycle management, which is priced as a percentage of collections banded by practice size — or as a flat monthly fee in states that do not permit percentage compensation of a billing company. Front-end services are also available on their own, per occurrence, without a billing contract.
Do you guarantee a result from eligibility & benefits verification?
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No, and nobody honestly can. Coverage, adjudication, payment amounts and appeal outcomes are decided by the payer. What we commit to is the process and the six numbers reported every month, all of which you can reproduce from your own practice management system rather than take on trust.
Can we buy eligibility & benefits verification without moving all of our billing?
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Front-end services are sold per occurrence and stand alone. The back-end work is harder to separate — denial management without control of coding and submission means inheriting problems created upstream — but we will say plainly which parts make sense on their own rather than sell a partial engagement that cannot succeed.
Ready for books you can actually trust?
Book a free consultation and we will tell you what your revenue cycle needs and what it costs.
- Done-for-you
- Solo or group
- Nationwide
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