Insurance & Eligibility · Eligibility

What Is Eligibility Verification? #

Eligibility verification asks a payer for current coverage and benefit information using patient and subscriber details. It is an important front-end check, but it is not a promise that a specific claim will be paid.

What to do #

1. Verify the patient, payer, member ID, subscriber, relationship, and date being checked.
2. Run the practice’s approved eligibility workflow.
3. Review the returned coverage and benefit information.
4. Investigate mismatches before service or claim submission.

Verify before you finish #

• The response belongs to the correct patient and payer.
• The date checked is relevant to the planned service.
• Problems are corrected in the appropriate patient or payer record.