Real-time eligibility
Direct payer connections. Verification in seconds, not days. Refreshed before every visit.
Real-time eligibility checks, deductible status, and benefit breakdowns delivered to your front desk before every appointment. No surprise denials. No surprise patient bills.
Not just "active / inactive." A complete benefits picture, in plain English, ready for the front desk.
Direct payer connections. Verification in seconds, not days. Refreshed before every visit.
How much is met, how much is left, what the patient owes today. Front-desk-ready.
Plain-English summaries tailored to your specialty. Coverage limits, exclusions, prior auths.
Inactive plans, exhausted benefits, or prior auth needed flagged 48 hours before the visit.
Verification results posted right into your EHR. No copy-paste. No PDFs to print.
Every verification logged with timestamp, source, and snapshot. Bulletproof for disputes.
How we verify, what we deliver, and why front desks love it.
Active coverage status, plan effective and termination dates, copay, coinsurance, deductible (individual and family, met to date and remaining), out-of-pocket maximum, secondary insurance coordination, in-network status of your providers, and service-specific benefits (PT visits remaining, mental health visit caps, DME requirements, and so on).
New patient verifications turn around in under 24 hours, often same day. Established patient re-verifications run on a rolling schedule (every 30, 60, or 90 days depending on your specialty) so coverage changes never sneak up on you. Urgent same-day requests get prioritized.
Yes. Once we identify a service that requires prior auth, we initiate, follow through, and document the auth number. Pre-auth tracking includes expiration dates so you don't lose authorization between visits. Common procedures, surgeries, imaging, and certain medications are routinely auth'd before the visit.
A front-desk staffer typically spends 15 to 25 minutes per new patient on the phone with insurance. We move that off your team. They get a one-page benefits summary they can hand the patient at check-in, with the patient responsibility already calculated.
A clean one-pager: patient name, plan name, member ID, copay, deductible status, coinsurance, OOP max, in-network status, service-specific limits, and next step (collect $X at check-in, prior auth pending, secondary insurance on file, etc.). Front desk reads it in 15 seconds, patient signs it, you bill cleanly.
Most modern PMs (Athenahealth, Kareo, eClinicalWorks, AdvancedMD, NextGen, DrChrono, Practice Fusion) support automated eligibility queries. We layer on top of those for the data the automated check misses, especially benefit limits and prior auth requirements that real-time eligibility responses don't include.
Medicaid managed care plans churn often, especially during redetermination cycles. We re-verify Medicaid patients every 30 days as a default. After the post-PHE unwind, that cadence has caught more lost coverage at check-in than any other intervention we recommend.
30-minute free billing audit. We'll surface the leaks (undercoding, denials never appealed, eligibility errors) and quantify the dollars you can recover this quarter.
