Insurance Verification & Prior Auth

Eligibility Verification & Prior Authorizations

We handle eligibility verification, benefits verification, prior authorizations, referral management, and coverage determination to ensure your practice gets paid and patient visits are pre-approved without administrative delays.

How We Coordinate Insurance Approvals

Our dedicated specialists contact payers directly, document plan coverage limits, obtain required prior authorizations, and secure referral details before care is delivered. This prevents billing surprises, cuts down front-office administrative overhead, and decreases claim denials at the source.

Phase 1

Eligibility Verification

We verify patient eligibility with payers prior to service, ensuring active coverage status.

Phase 2

Benefits Verification

Detailed checks of patient benefits, copays, deductibles, and co-insurance thresholds.

Phase 3

Coverage Determination

Confirming if specific medical services, procedures, or drugs are covered under the policy.

Phase 4

Prior Authorization Processing

Submitting and managing authorization requests to prevent claim rejections.

Phase 5

Referral Management

Tracking and obtaining required primary care referrals for specialty services.

Phase 6

Authorization Follow-Up

Monitoring submitted authorizations to secure quick approvals and prevent scheduling delays.

Phase 7

Insurance Policy Validation

Ensuring all policy details are current, accurate, and properly loaded into the EHR.

Why Pre-Billing Insurance Verification Matters

Unverified eligibility is one of the leading causes of claim denials. By confirming benefits before the patient's visit, you protect your revenue stream, improve clinic workflows, and set clear payment expectations with patients upfront.