Insurance Eligibility Verification Services
Eligibility verification confirms that a patient's coverage is active, applies to the specific service being scheduled, and carries the benefit detail — copay, deductible position, visit limits — that determines what they will owe.
Trusted by 160,000 Providers
Why Insurance Eligibility Verification Matters
An eligibility problem discovered after a visit cannot usually be fixed. The care has been delivered, the cost incurred, and the claim will deny for a reason that existed before the patient walked in — which makes eligibility one of the only categories of denial that is genuinely avoidable if it is checked in time.
Real-time eligibility checks
Coverage verified against the specific plan close to the date of service.
Network status confirmation
Provider participation confirmed for the plan the patient is actually enrolled in.
Benefit and cost-share verification
Copay, deductible position and visit limits confirmed ahead of the visit.
Authorization flagging
Services requiring prior authorization identified while there is time to obtain one.
Secondary coverage sequencing
Additional coverage identified and billed in the correct payer order.
Recurring-visit verification
Coverage re-checked for patients with ongoing or recurring care schedules.
Complete Insurance Eligibility Verification Services
Verification checks more than whether a patient has insurance. It confirms the specific plan, whether the provider is in network for that plan, whether the service requires authorization, and what the patient's cost-sharing position actually is for that visit.
Because coverage can change between visits — a new plan year, a job change, a lapsed policy — verification is run close to the date of service rather than relied on from a prior visit, since older eligibility data is a common and avoidable cause of denials.
Where a plan carries specific requirements, such as a referral or prior authorization, that is identified during verification rather than discovered after the appointment, while there is still time to act on it.
Our Insurance Eligibility Verification Process
Every stage is defined, so you always know which claims are moving and what is being done about the ones that are not.
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01
Plan and coverage confirmation
Coverage is confirmed against the specific plan the patient is enrolled in, not just the carrier name, ahead of the appointment.
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02
Network and benefit checks
Provider network status and benefit detail — copay, deductible, visit limits — are confirmed for that plan and that service.
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03
Authorization identification
Any authorization or referral requirement is identified during verification, while there is still time to obtain it before the visit.
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04
Secondary coverage review
Additional coverage is identified and sequenced correctly so claims are billed to the right payer in the right order.
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05
Pre-visit communication
Verified coverage and estimated responsibility are communicated ahead of the visit so nothing about the balance is a surprise.
Trusted by Practices Nationwide
Healthcare providers across the country trust RevaxisMD with their revenue cycle operations.
★★★★★
As a solo practitioner I was drowning in administrative work and losing money on uncollected claims. Handing over the billing operation transformed our finances — revenue is up meaningfully in the first year and I can focus on patients instead of insurance paperwork.
★★★★★
Switching was the best decision we made for our practice. Within the first month we saw significant improvement in cash flow. The team is responsive, knowledgeable, and genuinely invested in our success — our collection rate improved sharply in just six months.
★★★★★
The transition was seamless and the ongoing support has been outstanding. They reduced our days in A/R dramatically and improved our cash flow. Their credentialing team also helped us get contracted with three major payers we had been trying to join for over a year.
Stop denials before they start.
We will review how eligibility is checked in your practice today and where gaps are creating avoidable denials.
Insurance Eligibility Verification — Common Questions
How close to the appointment is eligibility checked?
As close to the date of service as practical, since coverage can change between visits and older verification data is a common source of denials.
What information does verification actually confirm?
The specific plan, network status, benefit detail such as copay and deductible position, and any authorization requirement for the service being scheduled.
Can you verify coverage for recurring or ongoing patients?
Yes. Recurring visits are re-checked on a schedule appropriate to how often coverage or plan details are likely to change.
What happens when an authorization is required?
It is flagged during verification, before the visit, so there is time to obtain it rather than discovering the requirement after the claim denies.
Do you handle secondary insurance?
Yes. Secondary coverage is identified and sequenced correctly so claims are billed to the right payer in the right order.
Related services
Request a call back
Tell us about your practice and a member of the team will call you to talk through your insurance eligibility verification workflow.