🔍 Eligibility Verification Services

Insurance Eligibility Verification That Eliminates Claim Rejections at the Source

✓ Real-Time Verification✓ All Insurance Types✓ Benefits Analysis✓ Pre-Visit Checks
Get Free Consultation →📞 +1 (800) RCM-PROS

Overview

Insurance eligibility errors are the number one cause of preventable claim rejections, accounting for over 23% of all initial claim denials. A single unverified eligibility issue can delay payment by 30-90 days or result in complete write-offs.

Rafsons Med Billing performs comprehensive real-time eligibility verification for every patient visit, checking active coverage status, in-network benefits, deductible status, copay requirements, and authorization requirements — all before the patient arrives.

This proactive approach eliminates eligibility-related rejections, enables accurate patient financial counseling, and significantly improves your front-end revenue cycle performance.

Key Benefits & Outcomes

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Real-Time Verification

Instant eligibility checks through direct payer connections. Results in seconds, not hours.

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Eliminate Eligibility Rejections

Our pre-visit verification eliminates the number one cause of claim rejections before they happen.

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Accurate Patient Estimates

Precise benefit information enables accurate cost estimates and upfront patient collections.

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Benefits Breakdown

Detailed analysis of deductibles, copays, coinsurance, out-of-pocket maximums, and covered services.

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COB Identification

Coordination of benefits issues identified before claims are submitted, preventing coordination denials.

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Verification Reporting

Complete verification logs with timestamps, results, and exception reports for compliance and audit purposes.

Our Process

1

Appointment Data Import

We receive your daily appointment schedule via secure system integration or file transfer.

2

Real-Time Payer Query

Eligibility is verified against each payer system in real-time using ANSI 270/271 transactions.

3

Benefits Analysis

Results are analyzed for coverage status, benefits details, auth requirements, and COB issues.

4

Exception Flagging

Any eligibility issues are flagged for front desk resolution before the patient arrives.

5

Results Delivery

Verified eligibility data is returned to your system or delivered via secure report before patient arrival.

Frequently Asked Questions

How far in advance do you verify eligibility?+
We verify eligibility 1-3 days before scheduled appointments and again on the date of service for high-risk payers. For urgent care and emergency visits, we verify in real-time at point of registration.
What information does eligibility verification provide?+
Our verification includes active coverage status, effective and termination dates, plan type, in and out-of-network benefits, deductible status, copay and coinsurance amounts, out-of-pocket maximum status, covered services, authorization requirements, and COB information.
Do you verify Medicare and Medicaid eligibility?+
Yes. We verify Medicare Part A, Part B, Medicare Advantage, Medicaid, CHIP, and all dual-eligible combinations. We also check Medicare ABN requirements and Medicaid managed care plan specifics.
How does this integrate with our scheduling system?+
We integrate with your scheduling or practice management system via HL7, API, or secure file transfer. Verification results are automatically returned so front desk staff see eligibility status directly in the patient record.

Stop Eligibility Errors Before They Happen

Real-time verification before every visit eliminates the most preventable source of claim rejections.

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