Eligibility and benefits verification
Eligibility and benefits verification confirms a patient’s active coverage and specific plan details before the visit happens, not after.
Follows patient registration. Feeds into prior authorization.
Where practices lose money here
Coverage checked too late or not at all
A lapsed policy discovered at check-in either delays the visit or turns into an uncollectible self-pay balance.
Benefit specifics get skipped
Confirming "active" coverage without checking deductible remaining, copay, or visit limits means the practice under-collects at time of service and chases the balance later at a fraction of the cost.
How we handle it
Verify eligibility 48 to 72 hours before each scheduled visit using payer portals and clearinghouse eligibility feeds.
Confirm active coverage, plan type, and in-network status for the specific provider seeing the patient.
Pull deductible remaining, copay, coinsurance, and out-of-pocket maximum so the front desk can collect an accurate estimate at check-in.
Check telehealth coverage separately when the visit is virtual, since benefits often differ from in-person.
Check benefit limits on visit-capped services, such as physical therapy or behavioral health sessions, against units already used.
Flag coverage problems to the practice and the patient with enough lead time to reschedule or resolve before the visit.
What you receive
Concrete output for this step, delivered on a set schedule rather than on request.
- A daily eligibility report for the next one to three days of scheduled visits.
- A flagged-issues list for coverage lapses, plan changes, or benefit limits reached.
Where this sits in the cycle
This step catches coverage problems while there is still time to act on them. It sits between scheduling and the visit itself, and it directly reduces what shows up as a denial later.
Questions about this step
What if a patient’s coverage changed and we did not know?
That is exactly what this check catches. We flag it before the visit so the front desk can address it with the patient rather than the biller finding out after a denial.
Do you check secondary insurance too?
Yes, when it is on file. Coordination of benefits gets confirmed as part of the same check.
Want us to review how this is handled in your practice right now?
The free billing audit looks at eligibility and benefits verification alongside the rest of the cycle, and comes back with specific findings.