Insurance eligibility verification is more critical than ever. A patient can have active coverage one month and stop paying premiums the next, and under Affordable Care Act grace periods, claims for services in the second and third months can go unpaid if the premium isn’t caught up, leaving the practice to collect from the patient.
Verifying eligibility makes sure the patient has coverage, the services are covered, and the right authorizations are in place, so denials and appeals are minimized and payments come in at the appropriate rates. Claims denied for no active coverage, out-of-network status, or unauthorized procedures are a major, avoidable loss of revenue.
This orthopedic practice was losing thousands monthly due to preventable denials and poor documentation. After restructuring their billing workflow and improving coding accuracy, we slashed their denial rate by 60% and restored consistent reimbursements.
Coverage changes more often than most practices expect. Checking before each visit catches plan changes, lapsed coverage, and authorization needs before they turn into denials.
Yes. Elevate submits and tracks prior authorization requests so procedures aren’t performed without the approval the payer requires.