Insurance & Eligibility · Eligibility
Active Coverage #
An active eligibility response indicates that the payer reports coverage for the queried patient/date under the returned benefit information.
What to do #
- Verify the response belongs to the intended policy.
- Review the effective dates and benefit details returned.
- Check whether limitations, network information, or service-specific details are included.
- Continue normal front-end verification for authorization or referral needs when applicable.
Verify before you finish #
- Patient and payer match.
- The relevant date falls within the returned coverage period.
- Active coverage is not being treated as guaranteed payment.
Important
Active coverage does not establish that every planned service is covered or payable.