Insurance Eligibility Verification
Verify coverage before the visit so claims go out clean.
How AccMed RCM Handles Insurance Eligibility Verification
Every denied claim that traces back to inactive coverage or a missing authorization is preventable. AccMed RCM checks each patient’s insurance eligibility before the appointment, confirming active coverage, plan type, deductible status, copay and coinsurance amounts, and whether the scheduled service needs prior authorization. Your front desk receives a clear summary it can act on, and your billing team works from verified information instead of assumptions that surface weeks later as denials.
We verify benefits through payer portals, clearinghouse eligibility transactions (270/271), and direct payer calls when automated responses are incomplete. Verification covers primary and secondary coverage, coordination of benefits, referral requirements, and visit limits for therapy and behavioral health services. Results are documented in your practice management system before the date of service, so scheduling, patient estimates, and claim submission all start from the same verified facts.
What Our Insurance Eligibility Verification Cover
Real-time eligibility checks
We run 270/271 eligibility transactions through your clearinghouse ahead of scheduled appointments.
Benefits breakdown
Copay, coinsurance, deductible met and remaining, and out-of-pocket maximums are recorded for each patient.
Prior authorization screening
Services that require authorization are flagged early so your team can request approval before the visit.
Secondary coverage and COB
Secondary and tertiary plans are identified and ordered correctly to prevent coordination-of-benefits denials.
Referral and visit-limit checks
HMO referral requirements and visit caps for therapy services are confirmed before scheduling.
Patient cost estimates
Expected patient responsibility is documented so your front desk can collect accurately at check-in.
Re-verification for recurring visits
Coverage is re-checked for patients in ongoing treatment plans, where eligibility changes are common.
Why Practices Choose This Service
Fewer eligibility denials
Claims are submitted against confirmed active coverage, reducing avoidable front-end rejections.
Accurate patient collections
Knowing copays and deductible status upfront means fewer surprise balances after the visit.
Better scheduling decisions
Staff can resolve coverage problems before the patient arrives, not after the claim denies.
Cleaner downstream billing
Correct payer order and plan details reduce rework in posting, follow-up, and appeals.
Documented audit trail
Every verification is recorded in your system, supporting appeals when payers dispute coverage.
What We Verify Before Every Visit
- Active coverage on the date of service
- Correct payer, plan and payer ID (including Medicare Advantage and Medicaid managed care plans)
- Primary and secondary coverage order (coordination of benefits)
- Copay, coinsurance, deductible and out-of-pocket amounts remaining
- Specialty benefits such as therapy visit limits or behavioral health carve-outs
- Referral and prior authorization requirements
- In-network status for the rendering provider
Who Benefits Most
How This Fits Your Revenue Cycle
Every service we offer connects to one complete billing workflow, so nothing falls between the cracks:
Insurance Eligibility & Verification
We confirm coverage and benefits before a claim is ever created.
Charge Entry & Medical Coding
Charges are captured and coded accurately with CPT and ICD-10.
Claim Scrubbing & Submission
Every claim is checked for errors, then submitted electronically.
Payment Posting
Payer payments and adjustments are posted accurately from remittance data.
Denial Management & Appeals
Denials are reviewed, corrected, and appealed where appropriate.
A/R Follow-Up
Unpaid claims are tracked and followed up until resolved.
Patient Billing
Patient statements and balances handled with clear, simple workflows.
Reporting & Analytics
Regular reports on claims, payments, denials, and A/R aging.
Insurance Eligibility Verification for Every Specialty
Our workflows adapt to your specialty’s coding rules and payer requirements. See the full list on our specialties page.
Insurance Eligibility Verification Questions, Answered
How far in advance do you verify eligibility?
We typically verify coverage two to three business days before the appointment, and again on the day of service for same-week schedule changes. For recurring treatment plans, verification repeats monthly because coverage can change mid-plan.
What information do you need from our office?
We work from your schedule and the patient’s insurance card details: member ID, group number, and date of birth. If a payer response is incomplete, we call the payer directly and document the reference number.
Do you check prior authorization requirements as part of verification?
Yes. Eligibility verification includes screening the scheduled CPT codes against the plan’s authorization rules. When authorization is required, we flag it to your team with enough lead time to submit the request before the visit.
Can you verify coverage for walk-in or same-day patients?
Yes. Same-day requests are handled on a priority basis during business hours. If a payer portal is unavailable, we complete the check by phone and update the patient record the same day.
How far ahead of the visit do you verify eligibility?
Usually one to three business days before scheduled appointments, with a same-day recheck for new patients and walk-ins where possible.
Do you verify secondary insurance too?
Yes. We confirm coordination of benefits so claims go to the right payer first and secondary claims are not rejected.
What happens if coverage is inactive?
We flag it to your front desk before the visit so you can ask the patient for updated insurance or discuss self-pay options.
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