Before the visit

Insurance Eligibility Verification

Confirming active coverage, copay, deductible and referral requirements before the patient arrives.

Confirming active coverage, copay, deductible and referral requirements before the patient arrives.

Checking coverage one patient at a time by phone or portal is the most expensive way to get an answer that is available in bulk. Skipping it is worse: the visit happens, the claim is denied, and the balance becomes a patient-collections problem instead.

What goes wrong today

Checking coverage one patient at a time by phone or portal is the most expensive way to get an answer that is available in bulk. Skipping it is worse: the visit happens, the claim is denied, and the balance becomes a patient-collections problem instead.

What good looks like

Coverage checked ahead of the visit, with copay and deductible known at check-in and referral or PCP requirements surfaced before they become a denial.

  • Batch checks ahead of the schedule, not one at a time
  • Copay and deductible known before arrival
  • Referral and PCP requirements flagged early
  • Self-pay path when coverage is inactive

What to measure

Pick these before you change anything, so the effect is visible rather than anecdotal.

  • Share of visits verified pre-service
  • Denials for eligibility reasons
  • Point-of-service collection rate

Where we stand: In development

In development. A clearinghouse covers this well today and is the honest recommendation in the meantime.

Rollout checklist

  • Document how this is handled today, and by whom.
  • Put a number on the hours or dollars involved.
  • Decide which cases must always reach a person.
  • Agree the metrics you will judge success on.

Frequently asked questions

Do you solve this today?

In development. A clearinghouse covers this well today and is the honest recommendation in the meantime.

How do we work out whether this is our biggest gap?

The Front Desk Opportunity Scan estimates the hours and revenue behind each area from your own volumes and ranks them against each other.

Keep going on MedReception.ai

MedFrontDesk.ai is the playbook library. MedReception.ai is the platform that runs it.

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