Insurance

Eligibility Verification

The process of confirming a patient's insurance coverage, benefits, copay, deductible status, and authorization requirements before providing services.

In Detail

Real-time eligibility verification prevents claim denials caused by inactive coverage, exhausted benefits, or unmet deductibles. Key data points include: plan type (HMO/PPO), copay amount, deductible remaining, visit limits, prior auth requirements, and referral requirements. PRACTIS runs automated eligibility checks 48 hours before each appointment, flagging coverage issues before the patient arrives. This prevents an estimated $2,400/month in denied claims per clinician.

Related Search Terms

PT eligibility verificationinsurance eligibility checkreal-time eligibility

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Automating Insurance Eligibility Checks Before Every Visit

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Related Terms

Explanation of Benefits (EOB)

EOB

A document from an insurance company explaining how a claim was processed, including what was paid, denied, and what the patient owes.

Prior Authorization

Prior Auth

A requirement by insurance companies for providers to obtain approval before delivering certain services, ensuring the services are medically necessary and covered under the patient's plan.

Eight-Minute RuleExplanation of Benefits (EOB)
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