Most write offs are decided before the patient walks in.
Doctor, by the time a coverage problem shows up as a denial it is six weeks old and the visit already happened. Checking eligibility properly before the appointment turns that denial into a phone call your front desk makes on Tuesday.
Start the visit with better information
Coverage and benefits should be reviewed before a claim is created. We check the available plan information, flag limitations and pass the relevant details back to your team for the upcoming service.
Verify the plan
Review benefits
Share the findings
Coverage had already ended
The patient changed employer, the plan renewed on the first of the month, or the policy was terminated. The card in your file is real and it is also out of date. Nobody finds out until the payer says so.
Active coverage, wrong benefit
The plan is live, so the check passes, but the specific service is not covered, needs a referral, or sits under a separate behavioral or therapy benefit with its own limits. Active is not the same as covered.
Money you could have collected at the desk
Nobody quoted the copay or told the patient the deductible was unmet, so the balance becomes a statement, then a second statement, then a collections decision on an amount you could have taken at check in.
How we verify
Here is what the work looks like, from the first review to the next action.
A defined task.
A documented action.
A visible next step.
Run the schedule ahead, not the morning of
The upcoming schedule is worked in advance, so a coverage problem is found while there is still time to fix it, reschedule, or tell the patient what they will owe.
Confirm the plan, not just the policy
Payer, plan, group number and effective dates are confirmed, along with whether this is primary or secondary. A patient with two plans billed in the wrong order is a guaranteed rework.
Read the benefit for the service booked
Coverage is checked against what the patient is actually coming in for, including visit limits, referral requirements and whether a prior authorization is needed.
Quote the patient responsibility
Copay, remaining deductible and coinsurance are recorded on the appointment so your front desk knows what to collect before the patient is seen.
Flag the failures by name
Anything inactive, out of network or needing an authorization goes back to your team as a short list with the reason, not as a spreadsheet nobody opens.
Included in eligibility verification
Agree the scope with your practice, then keep the day-to-day work organized around it.
- Verification ahead of the appointment
- Payer, plan, group and effective dates confirmed
- Primary and secondary order established
- Benefit checked against the booked service
- Copay, deductible and coinsurance recorded
- Referral and authorization requirements identified
- Inactive and terminated coverage flagged
- Daily exception list to your front desk
Eligibility is information, not a payment guarantee
An active policy does not by itself confirm that every service is covered. Benefits, limitations, authorization requirements and coordination of benefits still need attention for the planned visit.
Checked properly, or checked quickly
Most practices do run eligibility. The difference is how much of the answer they read.
| Situation | A quick check | How we work it |
|---|---|---|
| Plan shows active | Marked verified and moved on | Benefit for the booked service is read as well |
| Patient has two plans | Billed to whichever is on file | Primary and secondary order confirmed first |
| Deductible is unmet | Discovered on the remittance | Quoted to the front desk before the visit |
| Service needs authorization | Found out when it denies | Flagged before the appointment |
| Coverage ended last month | Claim denies, patient is billed | Caught while the visit can still be discussed |
A few things to know before we start
The right scope starts with a clear conversation.
Ask it directly. You will get an answer from somebody who works accounts, not a sales script.
Monday to Friday, 8am to 5pm Central TimeHow far ahead do you check?
Far enough ahead that a problem can still be acted on, and re-checked closer to the date for appointments booked well in advance. Coverage changes at month end more often than people expect.
Do you contact the patient?
That is your call. Some practices want us to stop at the exception list and make the call themselves, others want us to handle it. We do not contact a patient without your say so.
What about walk ins and same day adds?
Same day additions are checked the same day. We would rather give your desk an answer an hour late than not at all.
Is this included in full billing?
Yes. If we run your billing, eligibility is part of it. This page exists because some practices want only this piece, and that is a reasonable place to start.
Most practices do not buy one service in isolation. These are the ones that change the same numbers.
Find out how many of your denials started before the visit
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.