Eligibility Verification
We confirm every patient's insurance coverage, benefits, and authorisation status before they even walk through your door — eliminating the #1 root cause of claim denials.
Eligibility Verification — What We Do
Eligibility verification is the foundation of a clean revenue cycle. When coverage is not confirmed in advance, practices face surprise denials, delayed payments, and patient billing disputes that erode trust and revenue simultaneously.
Care Medicus performs real-time eligibility checks through payer portals and clearinghouse connections for every scheduled patient, typically the day before the appointment. We capture deductibles, co-pays, co-insurance, out-of-pocket maximums, and any referral or authorisation requirements.
Any issues — lapsed coverage, incorrect plan IDs, or required prior authorisations — are flagged to your front desk before the patient arrives, giving your team time to resolve them proactively.
What's Included
- Real-time eligibility checks via payer portals
- Benefits breakdown: deductibles, co-pays, co-insurance
- Prior authorisation status and requirements
- Coordination of benefits (COB) identification
- Secondary insurance discovery
- Same-day verification for walk-in patients
- Issues flagged to front desk before appointment
- All results documented in your PM system
Questions About This Step?
Our billing specialists are available to walk you through exactly how we handle eligibility verification for your specific specialty and payer mix.
Talk to a Specialist View Full Process OverviewOur 5-Step Billing Process
You are on Step 1. Every step is connected and managed by Care Medicus.