Eligibility & VOBs determine patient responsibility (co-pay, deductible, OOP max, coverage limits). Verifying benefits before appointments prevents claim denials and improves point-of-service collections.
Common Problems:
Unpaid patient balances
Unexpected denials for non-covered services
Delays due to retroactive eligibility changes
Our Solution:
Real-time payer eligibility checks
Benefit breakdowns
Verification notes attached to patient chart
Pre-authorizations when needed
Process:
Automated eligibility checks on scheduling
Manual secondary verification for complex cases
Estimated patient responsibility communicated prior to visit
Benefits: Accurate patient estimates, fewer claim denials for eligibility, better collection at time-of-service.
KPIs We Track: Eligibility verification completion rate, accuracy of patient estimates, reduction in eligibility-related denials.
FAQ:
Q: Will you estimate patient out-of-pocket costs?
A: Yes — we provide an estimate and note any limitations or prior authorization needs.
We identify your needs and devise customized solutions as per requirements.
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