Insurance Eligibility Verification Services
Coverage confirmed before the visit, so the claim is not dead before it is filed.
Eligibility verification is the cheapest work in the revenue cycle and the most expensive to skip. Confirming coverage, benefits and authorisation before a patient is seen costs a few minutes. Discovering after the visit that the plan terminated, the service needed prior authorisation, or the provider is out of network costs the entire claim.
Coverage is not static. Plans change at renewal, employers switch carriers, patients move between commercial and Medicaid, and deductibles reset every January. A card photocopied eight months ago tells you almost nothing about today.
We verify every scheduled patient before the visit and tell your front desk what to collect, so the money conversation happens at check-in rather than in a statement three months later.
The problem
Where this usually goes wrong
Coverage terminated and nobody knew
The patient presents the same card they have had for two years. The plan ended in March. The claim is denied for no active coverage and the balance lands on a patient who thought they were insured.
Prior authorisation missed
Some services need approval before they happen. Authorisation obtained after the fact is usually not accepted, which turns a payable claim into a write-off or an uncomfortable patient conversation.
Nothing collected at the desk
If nobody knows the deductible status or copay before the visit, the front desk collects nothing. That balance then costs several statements and a phone call to recover, if it is recovered at all.
What is included
- Verification of every scheduled patient, typically 48 to 72 hours ahead
- Real-time electronic checks against the payer, not a photocopied card
- Active coverage, effective dates and plan termination confirmed
- Copay, deductible remaining, coinsurance and out-of-pocket maximum
- In-network status confirmed for the specific rendering provider
- Prior authorisation and referral requirements flagged before the visit
- Secondary and tertiary coverage identified so claims coordinate correctly
- A daily worklist for your front desk with what to collect from whom
How it runs
Our process
- 1
Pull the schedule
We read the coming week’s appointments straight from your PM system. No list to send us, no spreadsheet to keep updated.
- 2
Verify electronically
Each patient is checked against the payer directly for active coverage, benefit detail and network status for the provider they are actually seeing.
- 3
Flag the exceptions
Most patients verify cleanly and need no attention. The ones that do not — terminated plans, authorisation required, out-of-network provider — come to your front desk as a short exception list.
- 4
Chase authorisations
Where a service needs prior approval we start the request and track it to a decision, rather than handing you a note saying authorisation is required.
- 5
Hand off to the desk
Your staff get the collectable amount per patient before arrival, so the copay or deductible conversation happens at check-in when the patient is standing there.
Verifying before the visit compared with finding out afterwards
| Metric | Billing in house | With AsesorMD |
|---|---|---|
| When coverage is checked | At check-in, or not at all | 48 to 72 hours before the visit |
| Terminated plans caught | After the denial | Before the patient arrives |
| Prior authorisation | Discovered when the claim is denied | Flagged and chased in advance |
| Collected at the desk | Usually nothing | Copay and deductible, with the amount known |
| Cost to fix | A rework, an appeal or a write-off | A few minutes of verification |
Questions we get asked
How far in advance do you verify?
Normally 48 to 72 hours before the appointment. Far enough ahead to chase an authorisation or warn the patient, close enough that the coverage information is still current on the day.
Do you handle same-day and walk-in patients?
Yes. Same-day additions are verified in real time as they are booked. The turnaround is minutes rather than days because the check is electronic.
What happens when a patient has no active coverage?
Your front desk gets told before the visit, with the termination date. That gives the practice the choice of rescheduling, collecting self-pay up front, or seeing the patient anyway as a deliberate decision rather than an accident.
Do you obtain prior authorisations as well as flag them?
Yes. We initiate the request, supply the clinical documentation the payer asks for, and follow it to approval or denial. You get told the outcome, not just that one was needed.
Will this work with our practice management system?
We work inside your existing PM and EHR and read the schedule from there. There is no separate system for your staff to learn and no export to maintain.
Can we buy verification without the rest of the billing?
Yes. Some practices keep everything else in house and hand us only eligibility, because it is the piece that gets skipped when the front desk is busy.
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com