Coverage, copays, and authorization requirements are verified before every appointment — not discovered afterward, when the only options left are a denied claim or a surprised patient.
Other billing scopes
Confirming the plan is active and in force on the date of service — not lapsed, not yet effective.
Copay, coinsurance, and remaining deductible, so patients aren't surprised by a bill after the visit.
Whether the specific service needs prior authorization, and whether one is already on file.
Confirming the provider is in-network for that specific plan, not just that plan's parent insurer.
A patient's plan verified at intake in January isn't guaranteed to be the plan they have in June — employer changes, open enrollment, and lapses all happen quietly, mid-treatment. Verifying only once, at intake, is one of the most common blind spots in behavioral health billing.
Insurance eligibility and benefits are verified through Availity before appointments, along with payer-specific portals where a plan requires it — so your practice avoids claim denials and patients aren't surprised by costs after the visit.
One of the most common denial reasons — and one of the most preventable, since coverage status is knowable before the visit.
A patient blindsided by an unexpected bill is more likely to dispute it, delay paying it, or leave the practice altogether.
Catching an authorization requirement before the visit means it can actually be obtained in time — not after the session already happened.
Eligibility results are shared with your Virtual Assistant team, so any cost-sharing conversation with the patient happens ahead of the visit, calmly — not at checkout.
Eligibility verification is part of our full Medical Billing service — 2.5% to 5% of collections, no flat monthly fee.
Book a Free ConsultBefore every scheduled appointment — not just at intake — since coverage can change month to month.
Active coverage status, copay and deductible amounts, whether the specific service requires prior authorization, and whether the provider is in-network for that plan.
Availity, along with payer-specific portals where a plan requires it.
It's flagged before the visit so the authorization can be requested in time — handled by your Virtual Assistant or escalated into Denial Management if it's already past due.