Eligibility & Benefit Verification

The majority of claims are refused because the patient’s eligibility and benefits verification are not checked, and the insurance provider does not cover the patient or service. Establishing an insurance verification method or collaborating with a professional organization might save the practice a substantial amount of money. Through eligibility verification methods, healthcare providers may submit clean claims.

As a result, claim resubmissions are avoided, demographic rejections and denials are minimized, and upfront collections are increased, resulting in enhanced patient satisfaction and accurate medical billing. Our eligibility and benefits verification team improve the efficiency of your medical billing processes while also increasing the bottom line of your organization. It is critical to verify a patient’s insurance benefits and eligibility before offering healthcare services to them.


The Revenue Cycle Management process’s first stage is verifying eligibility and benefits. Aside from human mistakes, incorrect or outdated insurance information is a primary cause of claim denials. Appropriate co-pays are difficult and time-consuming to collect if they are not received at the time of service. The process through which medical practitioners determine if a patient has active coverage with an acceptable payer is known as eligibility verification. Insurance companies make policy changes on a regular basis that may influence patient eligibility. Coverage may potentially vary due to Medicare eligibility, ACA marketplace renewals, or job changes. It may be terminated owing to nonpayment, changes in the family status, or the removal of a dependant from a covered insurance plan.