Eligibility Verification
Check coverage and eligibility against payer data and flag issues before the visit.
What It Does
When the next day's schedule is released, the agent runs every booked patient through the eligibility clearinghouse and returns the appointments where coverage is inactive, the plan on file does not match registration, or the benefit does not cover the booked service. Staff work that list before the patient arrives.Without it: Eligibility surprises at the desk delay care and create avoidable billing problems.
- Checks secondary and tertiary coverage on file, not only the primary plan
- Retries a clearinghouse timeout, then lists the patient as unverified rather than clear
- Puts the payer's own response code beside each flag for the staff call
- Orders the list by appointment time so the desk works it in arrival order
Illustrative example
Tomorrow's orthopaedic clinic schedule is released overnight. The agent returns the appointments that need a call: two plans terminated at the end of last month, one where registration holds the spouse's policy and the clearinghouse holds the patient's own, and one injection visit the benefit excludes, each with the payer response code beside it and sorted by slot time. The front desk works that list before the doors open, and sends the excluded injection visit to financial counselling.
Scheduling system
Tomorrow's booked appointments
Practice management
Plans on file
Eligibility clearinghouse
Payer coverage responses
Patient registration
Policy as registered
Eligibility verification
SuggestStarts when
The next day's appointment schedule is released
How far it goes
it proposes, and a person approves before anything commits
Coverage checks
Run on every appointment
Gap flags
Response code beside each
Staff-ready summary
Listed in arrival order
More Healthcare Agents
Prior-authorization drafting
Assemble prior-authorization requests against payer rules, ready for a clinician to review and submit.
Clinical-note summarization
Draft encounter summaries from the record, cited and masked, for a clinician to confirm.
Claims adjudication support
Read claims and supporting documents, check them against policy, and prepare a decision for review.
