Eligibility VerificationServices
Real-time eligibility verification and benefits checking to prevent claim denials. Expert eligibility verification services with 99.9% accuracy.
Eligibility and benefits verification is the first line of defense against claim denials. Over 25% of claim denials are directly linked to eligibility errors — wrong insurance information, inactive coverage, or incorrect co-pay collection. MedSure verifies patient eligibility and benefits before every appointment, ensuring your team has accurate information before the patient arrives.
Eligibility Verification Solutions
Specialized eligibility verification services designed to streamline your workflow.
Key Features
- Real-time eligibility verification
- Benefits checking and coverage details
- Pre-authorization requirements identification
- Copay and deductible information
- Insurance coverage validation
- Automated verification workflows
Benefits
- 99.9% verification accuracy
- Reduced claim denials due to eligibility
- Faster patient registration process
- Improved patient satisfaction
- Comprehensive coverage information
- 24/7 eligibility verification support
How It Works
Our proven process delivers results for your practice.
Pre-Appointment Verification
We verify insurance eligibility for every scheduled patient 24-72 hours before their appointment. This confirms active coverage, primary/secondary insurance, and whether the provider is in-network — giving your front desk time to address issues before the patient arrives.
Benefits Investigation
Beyond basic eligibility, we investigate detailed benefits: deductible and out-of-pocket status, co-pay vs. coinsurance structure, referral requirements, prior authorization requirements for the scheduled services, and coordination of benefits for patients with multiple payers.
Real-Time Eligibility Checks
For same-day appointments and walk-ins, we run real-time eligibility checks through our clearinghouse connections. Results are available in minutes and communicated to your front desk staff before the patient is seen.
Documentation & Follow-up
Eligibility results are documented in your practice management system. Discrepancies — lapsed coverage, incorrect member IDs, plan changes — are flagged immediately so your team can collect updated information or obtain correct insurance before services are rendered.
Frequently Asked Questions
Get answers about our Eligibility Verification services.
How far in advance do you verify eligibility?
We verify eligibility 24-72 hours before each scheduled appointment for routine visits. For procedures and surgeries with prior authorization requirements, we verify 5-7 days in advance to allow time for PA submission if needed.
Do you verify both primary and secondary insurance?
Yes. We verify primary insurance first, then check for any secondary or supplemental coverage. This ensures accurate coordination of benefits and maximizes what you collect across all payers — reducing patient balance surprises.
What if a patient's insurance has lapsed or changed?
We flag lapsed or changed coverage immediately and communicate it to your front desk team. Your staff can then contact the patient before the appointment to obtain updated insurance information, collect a self-pay deposit, or reschedule if needed.
Can you verify eligibility for different appointment types?
Yes. We tailor our benefits investigation to the scheduled service type. A routine office visit requires basic eligibility confirmation; a surgical procedure requires detailed benefits including deductible status, coinsurance percentages, and prior authorization requirements.
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