Eligibility & Prior Authorization

The cheapest denial is the one that never happens. We verify coverage and secure prior authorizations before patients arrive, eliminating the front-end errors that cause the majority of denials.

Ahead of every scheduled visit, we run a real-time eligibility check confirming active coverage, co-pay, deductible status, and referral requirements, and submit and track any prior authorization the visit or procedure requires. We also generate a patient cost estimate before the appointment, so your front desk can collect confidently at check-in instead of chasing a balance after the fact.

A surprisingly large share of prior-auth denials happen not because authorization was missing, but because it was obtained for the wrong CPT code, wrong date range, or wrong number of units — details that are easy to get wrong when it’s handled ad hoc between a busy front desk and a payer portal. We track the specific terms of every authorization against what’s actually billed, so a mismatch is caught before the claim goes out, not after it’s denied.

This service matters most for practices doing procedures, imaging, or specialty visits that commonly require prior authorization, but honestly any practice that’s been burned by an eligibility surprise at check-in benefits from having this handled systematically instead of ad hoc.

If your front desk has ever had to tell a patient at check-in that their insurance isn’t active, or a claim came back denied for a missing authorization that should have been caught days earlier, that’s this exact problem showing up after the fact instead of before.

Your scheduling stays the same; what changes is that by the time a patient arrives, their eligibility is already confirmed and any required authorization is already in hand, so your front desk is collecting an accurate co-pay instead of discovering a coverage problem in front of the patient.

This is deliberately the first line of defense in the revenue cycle — the fewer errors that start here, the less work lands on denial management later. We treat prevention here as cheaper and faster than any appeal after the fact.

Our standard is that a patient should never be the one to discover a coverage or authorization problem — if it wasn’t caught before the visit, we treat that as a miss on our end, not an acceptable exception.