Insurance Eligibility Verification instantly confirms a patient’s insurance status and benefits information at the time of scheduling or check-in. This single-click process queries the patient's insurer to verify that the policy is active and to pull relevant coverage details (copay, deductible, coverage limits)
Reliance on manual insurance verification—involving time-consuming phone calls and navigating multiple payer portals—creates dangerous timing gaps and high error rates, wasting hours of staff time, leading to claim denials, delayed reimbursements, and major revenue leakage across the healthcare industry.
Automated, real-time eligibility verification transforms a time-consuming task into a seamless pre-service process, instantly confirming patient benefits and providing the financial certainty needed to prevent costly delays and claim denials.
Staff can instantly query the carrier database in real-time within the scheduling or intake module.
Configurable system auto-runs eligibility for scheduled appointments (often overnight), marking as verified or flagging failures.
Returns plan details including copay, deductible status, out-of-pocket maximum, and service coverage limits.
System flags patients with inactive, terminated, or invalid coverage in the dashboard for prompt staff follow-up.
A record of the eligibility check (date, time, and reference number) is stored for compliance and auditing.
The system delivers crucial financial and operational results, helping providers reduce claim denial rates due to eligibility by over 20% and increase point-of-service collections, with continuous tracking of claim denial rates, check-in speed, and patient no-show rates.
The Real-Time Insurance Eligibility Verification platform is seamlessly integrated with existing Electronic Health Record (EHR), Practice Management Systems (PMS), and Enterprise Resource Management (ERM) systems. This interoperability ensures verified insurance data automatically populates billing forms, and the tool works with the CERTIFY Health Digital Intake module for immediate pre-service checks.
CERTIFY Health is a leading healthcare technology company specializing in patient engagement, intake, identity management, and revenue optimization.
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