Real-Time Eligibility & Benefits Checks
Our Eligibility and Benefits Verification Services help providers prevent costly claim denials, reduce patient confusion, and improve cash flow. Learn more about the HIPAA eligibility transaction standards on the CMS site.
Avoid Costly Surprises — Check Before You Bill
Missed eligibility checks are a top reason for denied claims. Our Eligibility and Benefits Verification Services verify every patient’s coverage in real time, helping you prevent delays and improve collections.
☑ Insurance is active
☑ Coverage type (PPO, HMO, Medicaid, etc.)
☑ Provider In Network or Out of Network
☑ Deductible and copay info
☑ Visit limitations or pre-auth needed
Everything You Need for Accurate Claims, Upfront
Our Eligibility & Benefits Verification Services confirm patient coverage before the visit, ensuring accurate claims, fewer denials, and faster reimbursements — so your revenue stays on track from day one. Learn more in Cigna’s official Eligibility & ID Cards Guide.
Real-Time Eligibility Checks
Detailed Benefits Summary
Copay/Coinsurance Info
Visit Limits & Authorization Requirements
Credentialing status
Documentation for Claim Submission
Why Our Eligibility and Benefits Verification Services Matter
Avoid last-minute surprises and ensure your services get reimbursed.
☑ Prevent claim denials by confirming coverage upfront
☑ Verify co-pays, deductibles, and service limitations
☑ Save staff time by automating routine verifications
☑ Improve patient satisfaction with cost transparency
☑ Ensure Medicaid eligibility before each visit
☑ Identify authorization requirements before rendering services
Eligibility and Benefits Verification Services FAQ
Why is eligibility verification important before every visit?
It helps avoid claim denials, ensures coverage is active, and informs both provider and patient about out-of-pocket costs.
How fast do you complete verifications?
For scheduled patients, we verify eligibility at least 24–48 hours in advance — and offer same-day checks for last-minute visits.
How much time can I save by outsourcing verifications?
On average, clinics save 6–10 hours weekly — time they can use for more patients, better service, or fewer billing headaches.
What happens if coverage changes after verification?
We recheck as needed and guide you on the best billing steps. If a claim is denied due to eligibility, we assist with appeals.
Will I know the exact copay or deductible before seeing the patient?
Yes. We include patient responsibility details (copay, coinsurance, deductible met/remaining) in your verification report.
How is your service better than doing it in-house?
We reduce errors, denials, and staff time — plus, we log every verification in writing with audit-ready documentation.
How do I handle patients with secondary insurance?
We verify both primary and secondary coverage and help you coordinate benefits correctly to avoid underpayments or denials.
What happens if the patient’s coverage is inactive?
We notify you immediately and provide alternate insurance options if available — or help you collect cash pay upfront.
Ready to Reduce Denials and Speed Up Reimbursements?
Fortify RCM’s Eligibility and Benefits Verification Services ensure every visit starts with accurate coverage information — no more surprises, no more delays.