Insurance eligibility verification and prior authorization services
Many denials start at the front desk. We verify coverage and benefits before each appointment and get the prior authorizations your services need, so claims are paid and patients know what they owe.
Eligibility and benefits verification
Coverage changes all the time: new jobs, new plans, Medicaid redeterminations and the start of a new plan year. Checking eligibility at every visit is the simplest way to prevent coverage denials and surprise bills for patients.
Active coverage
Confirm the policy is active on the date of service and the patient's details match.
Benefits and cost share
Copay, coinsurance, deductible met and remaining, and visit limits for the service.
Network status
Confirm your provider is in network for the patient's specific plan.
Coordination of benefits
Identify primary and secondary insurance so claims go to the right payer first.
Prior authorization services
Payers require prior authorization for more and more services, including imaging, procedures, specialty drugs, therapy visits and DME. A missing or expired authorization almost always means a denial that is hard to overturn. We handle the full process:
- Identify. Check whether the scheduled service needs authorization under the patient's plan.
- Submit. Send the request with the supporting clinical documentation through the payer's portal, fax or phone line.
- Follow up. Track pending requests and respond quickly to requests for more information.
- Record. Note the authorization number, approved units and dates in your system, and flag renewals before they expire.
Why front-end checks pay off
- Fewer eligibility and authorization denials, which are among the most common denial types.
- Patients know their cost share before the visit, so collections at check-in improve.
- Your front-desk staff spend less time on hold with payers.
Frequently asked questions
When do you verify eligibility?
We usually verify coverage one to three business days before each scheduled appointment, and again on the same day for walk-ins or new patients when needed.
Do you handle peer-to-peer reviews?
We schedule and prepare peer-to-peer reviews and gather the documentation. The conversation itself is with your provider.
Can a virtual assistant handle this work full time?
Yes. Many practices pair eligibility and authorization work with a dedicated virtual medical assistant who works your schedule.
Often paired with eligibility & prior auth
Find out where your practice is losing revenue
Book a free, no-obligation practice review. We look at your claims, denials and A/R and send you a written summary of what we would fix first.