Eligibility & Benefits Verification

Either way. Eligibility and benefits verification is included in our full revenue cycle management, and it can also run alongside the specific stages you hand to us. We work inside the EHR and practice-management systems you already use.

We verify before the visit or before delivery whenever scheduling allows, so coverage gaps are caught while there is still time to act. For recurring services like capped-rental DME or ongoing home health episodes, we re-verify on a cadence that fits the payer and the service, since plans and benefit limits can change month to month. Re-checking at the start of a new plan year is especially important, because deductibles reset and patients often switch plans.

We work inside the EHR and practice-management systems you already use, and we run electronic eligibility (270/271) through your existing clearinghouse or payer portals. You do not need to buy or learn a new platform; we act as an extension of your front office in the software your team already knows. Where a payer does not return a clean electronic response, we confirm by portal or phone and document what we found.

Automated 270/271 responses often come back thin, especially on benefit limits, prior-authorization requirements, and DME-specific coverage. When the electronic answer is incomplete or ambiguous, we go to the payer portal or call the payer to confirm the detail that matters before the claim goes out. We capture the reference or call-tracking number, so the verification is documented and defensible if the claim is ever questioned.

For DME we confirm the item is a covered benefit under the patient's plan, flag whether prior authorization or a documented order is required, and check capped-rental and frequency or quantity limits before delivery. We also surface when an item falls under competitive bidding or carries plan-specific medical-necessity requirements, so the supplier knows the coverage picture before the equipment goes out. The aim is to catch coverage and authorization gaps up front rather than after delivery, when a denial is far harder to recover.

Yes. We verify the primary plan and then confirm any secondary or tertiary coverage, along with the coordination-of-benefits order, so claims drop in the correct sequence. COB and Medicare-secondary situations are a common source of denials, so we flag them up front rather than letting them surface after billing. When the COB order on file looks wrong or outdated, we note it so your team can have it corrected with the payer.

Yes. We handle protected health information under HIPAA and operate under a Business Associate Agreement with each client before any verification work begins. Our staff access your systems with credentials and permissions you control, and we follow your access and security policies as an extension of your team. Because we work inside your environment, the eligibility data stays in your systems rather than being copied somewhere else.

We scope pricing on a consultation, based on your specialty, payer mix, volume, and whether verification runs on its own or alongside other revenue cycle stages. There is no flat public rate, because a high-volume DME supplier and a small specialty practice have very different verification workloads. After a short scoping call we can put a clear, specific proposal in front of you.

The verification lives in your EHR or PM system, attached where your team expects it, so coverage status, authorization flags, benefit limits, and patient responsibility are visible at the point of work rather than buried in a separate report. Because we work inside your existing systems, there is no separate portal to log into and no data handoff to reconcile. The result is a clean front end, which is the cheapest place to prevent a denial.