Eligibility Verification
Eligibility is the #1 reason claims get denied. We verify every patient before they walk in — active coverage, deductible, co-insurance, and benefit limits — so front desk knows what to collect and billing knows the claim will pay.
95%
Drop in eligibility denials
On accounts we verify pre-visit
100%
Pre-visit verification rate
Every appointment, 48 hours in advance
20%
Lift in upfront patient collections
Accurate co-pay quotes at check-in
A disciplined approach to eligibility verification
Most eligibility denials are preventable. They happen because somebody skipped a verification or trusted a stale insurance card. Once a claim denies for eligibility, you're 60+ days behind getting paid — if you get paid at all.
We verify 100% of scheduled patients 48–72 hours in advance: plan status, effective dates, deductible met-to-date, co-pay and co-insurance, out-of-network exposure, and benefit limits. Front desk gets a clean check-in sheet; billing gets a clean claim downstream.
What makes our eligibility verification different
Six advantages your team feels in the first 30 days.
100% pre-visit coverage
Every scheduled visit verified — not a sample, not after the fact.
48–72 hour lead time
Issues surface days before the visit so the patient can be contacted in time.
Patient-responsibility quote
Deductible, co-pay, and co-insurance estimated so front desk collects accurately.
Real-time + batch verification
Add-on real-time verification for same-day add-ons and walk-ins.
EHR-integrated alerts
Flags posted directly to the patient chart or schedule, not a separate spreadsheet.
Secondary & tertiary coverage
We map COB so the right payer is billed first — every time.
Everything inside the Eligibility Verification engagement
One flat scope. No surprises. No nickel-and-diming for the work that actually moves revenue.
Backed by our service guarantee
If our work doesn't move the metric in 90 days, we don't charge for the next month. Simple.
- Eligibility verification on 100% of scheduled visits, 48–72 hours pre-visit
- Plan-level benefit detail: deductible, OOP max, co-pay, co-insurance
- Primary, secondary, and tertiary coverage mapping (COB)
- Out-of-network and non-covered service flags
- Patient-responsibility estimate for front-desk collections
- Prior-auth required flag (handoff to auth team)
- Real-time verification API for same-day add-ons (optional)
- Weekly denial-prevention report
Our process, end-to-end
Five repeatable steps. No black-box. You see every handoff.
Schedule sync
Daily pull of the upcoming schedule from your EHR or PM system.
Coverage check
Verification by clearinghouse + payer portal + phone where required.
Benefit detail
Deductible met, co-pay, co-insurance, plan limits — all captured.
Chart-level alert
Findings posted to the patient chart with any red flags highlighted.
Front-desk handoff
Check-in team has a printable / on-screen summary with collection amount.
Coverage we verify
We work directly with the major clearinghouses and payer portals to verify nationwide.
Clearinghouses
Verification scope
Specialties supported
“Eligibility denials used to be 22% of our denial volume. Three months in with TrueClaim, they're under 3%. Front desk also loves having the co-pay number ready at check-in.”
Patricia R.
Revenue Cycle Director · Multi-clinic group, FL
HIPAA
Compliant workflow with BAA
US-Based
Operations and oversight
Encrypted
End-to-end data handling
Audit Trail
Every action logged
Everything you wanted to ask about Eligibility Verification
Can't find what you need? Ask a specialist.
Pair this service with
Prior Authorization Management
Prior auth shouldn't delay care or kill claims. We submit, escalate, and secure authorizations before the date of service — and capture every reference number in the chart so the claim never denies for missing auth.
Learn more →
Medical Billing & Coding
AAPC- and AHIMA-certified coders, end-to-end claim submission, and a quality program built to push your first-pass clean-claim rate above 99% — so revenue lands in days, not weeks.
Learn more →
Denial Management
Denials aren't an ending — they're a starting point. We work every denial within 24 hours, file structured appeals, root-cause the trend, and rewire your front-end so the same denial doesn't happen again next month.
Learn more →
See what eligibility verification
should be doing for you.
30 minutes with a specialist. We'll review your current performance, surface the top three opportunities, and tell you exactly what we'd change. No sales pitch.