Feature

Eligibility Verification

Verify patient eligibility in real-time or batch before services are rendered. Reduce front-end rejections and surprise balances with proactive coverage verification.

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Works with

Claims Submission & TrackingSubmit, track, and manage insurance claims with real-time status updates and automated scrubbing.
Patient StatementsGenerate, batch, and send patient statements with multiple delivery methods.
Payer Contract ManagementManage payer contracts, fee schedules, and submission rules in one place.

The cheapest denial to fix is the one that never happens because the front desk knew the coverage was inactive before the patient was seen. Eligibility Verification checks a patient’s coverage with the payer electronically, either at scheduling and check-in or in a batch for tomorrow’s appointments, and stores the response with the visit.

A verification response is more than active or inactive. It returns the plan, the copay, the deductible and how much of it is met, coinsurance, and whether a referral or authorisation applies. The platform shows that in a readable summary at the front desk so the copay collected is the right one and the patient is told about a deductible before the visit, not on a statement six weeks later.

Coverage changes. A patient verified in January may have a new plan in March. Batch re-verification runs against upcoming appointments ahead of the visit, and a change from the last stored response is flagged so staff look only at the patients whose coverage actually moved.

Key Benefits

Real-time verification

Batch processing

Coverage detail display

Automatic re-verification

What eligibility verification does

Real-time checks

Verify a single patient at scheduling, check-in, or any time coverage is in question, with the payer’s response in seconds.

Batch verification

Run the whole schedule for a day or a week ahead in one job, and review only the patients whose coverage is inactive or changed.

Benefit detail

Copay, deductible remaining, coinsurance, plan type, and referral or authorisation indicators are stored with the response and displayed in plain language.

Change detection

Each new response is compared with the previous one for that patient. A plan change, termination, or new subscriber ID is flagged for the front desk.

Stored with the visit

The verification used for a date of service stays attached to that visit, so a later eligibility denial can be answered with the payer’s own response.

Feeds the claim scrubber

Subscriber and plan details from the response are compared with the claim before submission, catching mismatches that would otherwise reject.

How It Works

Schedule

As appointments are booked, the patient’s insurance on file is queued for verification ahead of the visit.

Verify

The payer is queried in real time or in the nightly batch. The response is stored and summarised for the front desk.

Act

Inactive coverage, changed plans, and authorisation requirements are flagged so staff can update insurance, collect the right amount, or obtain an authorisation before the visit.

Defend

When a payer later denies for eligibility, the stored response for that date of service is the evidence for the appeal.

Frequently asked questions

How far ahead should eligibility be checked?

Close enough to the visit that the answer is still true. Most practices run a batch one to three days before the appointment and re-check at check-in for anything flagged. The platform lets each practice set its own window.

What does the verification tell the front desk?

Whether coverage is active for the date of service, the plan, the copay to collect, how much of the deductible is left, coinsurance, and whether a referral or authorisation is needed. It is summarised in plain language rather than shown as the raw payer response.

Does an eligibility check mean the claim will be paid?

No payer treats an eligibility response as a promise to pay, and neither should a practice. It confirms coverage and benefits as of the check. What it does give the practice is evidence: an eligibility denial can be answered with the payer’s own response for that date of service, which is usually enough to overturn it.

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Built for healthcare practices that are done fighting their billing software.

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