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Insurance eligibility verification, done before the claim goes out.

A claim sent for a patient whose coverage has ended will come back unpaid. Our team checks coverage and plan details for the date of service in the payer portal or by phone, and records what we find in your system.

Talk to our billing team How we work
What we check
  • Coverage active on the date of service✓
  • Plan and member details✓
  • Enrollment or termination status✓
  • Provider details on file✓
  • Duplicate records✓
The short answer

What is insurance eligibility verification?

Insurance eligibility verification means confirming, before a claim is billed, that the patient has active insurance coverage for the date of service and that the plan covers the service. It is one of the simplest ways to prevent denials, because a large share of unpaid claims trace back to coverage that had ended or member details that did not match.

Our team checks eligibility through the payer's portal where one is available, and calls the insurer when the portal does not give a clear answer. We work requests in the order we receive them, and share the result by email or by updating your system, whichever you prefer.

We also verify eligibility after the fact. When a claim is denied or rejected for a coverage reason, we look up the patient's coverage and plan details for the date of service, correct what was wrong, and resubmit the claim or follow up with the payer.

How we work

How we verify eligibility.

Requests are worked in the order they arrive. Daily volume per person follows your incoming work, so we staff to your volume rather than a fixed quota.

  1. 1
    Receive the requestFrom your schedule, a work queue in your billing system, or a list you send.
  2. 2
    Check the payer portalWe confirm the member, the plan, and that coverage is active for the date of service.
  3. 3
    Call when neededIf the portal is unclear or not available, we call the insurer and log the call reference number.
  4. 4
    Record and shareWe update your system or email you the result, and flag anything that needs your decision.
What is included

What eligibility work covers.

Before the visit

  • Active coverage on the date of service
  • Member and plan details
  • Provider information on file

Enrollment checks

  • Enrollment and termination status
  • COBRA letters
  • Duplicate member records

After a denial

  • Coverage review for the date of service
  • Correction of member or plan details
  • Resubmission or payer follow-up

Coordination

  • Calls with the carrier on coverage questions
  • Working with the facility and the carrier together on benefit usage issues
Working time

Average time we spend on each item

TaskAverage time
Eligibility check in a payer portalAbout 5 minutes per claim
Eligibility check by phone10 to 15 minutes per claim

This is hands-on time per item, not a promise of when your whole queue is cleared. Queue timing depends on your volume and is agreed with you at the start.

Systems

Portals we check eligibility in

  • Availity
  • UnitedHealthcare
  • Aetna
  • Cigna
  • BCBS
  • Medicare and Medicaid portals
  • Sunshine Health
  • Community Care Plan
  • Oscar Health
  • Simply Healthcare

Using something else? Tell us which system you use. We will say plainly whether we have worked in it before.

Patient data

We sign your Business Associate Agreement before we see any patient data.

Our parent company, Hire My Assistants KPO LLP, is HIPAA compliant.

Your BAA, signed

We sign the Business Associate Agreement your practice or plan uses, before any access is set up.

Work in your systems

We work directly in your billing or claims system, or through the VPN or virtual desktop you provide. We never download or store patient data.

A controlled floor

Restricted, monitored workstations, multi-factor login, encrypted devices, and access logs. No phones or writing material on the floor.

Checked and trained staff

Every team member passes police verification and an outside background check, and completes HIPAA training when they join the team.

Questions

What practices and plans ask us.

How long does an eligibility check take?
About 5 minutes per claim when the payer portal has the information, and 10 to 15 minutes when we need to call the insurer.
Do you call the insurance company?
Yes, when the portal does not answer the question. We log every call with its reference number.
How do we get the results?
By email or as updates in your billing system, whichever suits your team.
Can you check eligibility on claims that were already denied?
Yes. We review the denial reason, check coverage for the date of service in the payer portal, correct the error and resubmit the claim or follow up with the payer.
How many checks can you handle a day?
We staff to your volume. Tell us your average daily checks and we will plan the team around it.

More medical billing services

Medical Billing Services Prior Authorization Claim Submission & Rejections Denial Management & AR Follow-up Payment Posting & Recoupments Provider Credentialing Claims Processing for Payers Member Enrollment & Terminations
Get started

Send us your eligibility workload.

Tell us how many checks you run a day, which payers you see most, and where your schedule lives. We reply within one business day.

  • We sign your Business Associate Agreement
  • US business hours, overnight or 24/7 shifts
  • $9 an hour, one rate for all billing work
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