Front of cycle
Stop denials before the patient is seen
Eligibility and benefits verified ahead of the visit, authorizations tracked, and coverage confirmed while there is still time to do something about it. The cheapest denial is the one that never happens.
Eligibility is where denials are born
Front-end failures are the largest single source of denied claims. In a 2025 provider survey, missing or inaccurate data drove 50% of denials and incomplete or inaccurate patient registration data drove 32% — both up year over year (Experian Health, 2025). A separate MGMA poll of 235 medical groups named patient eligibility issues and incorrect ID numbers among the top causes of rising denials (MGMA, 2024).
The economics are lopsided. Verifying coverage takes minutes at the front desk. Appealing the resulting denial takes weeks, costs materially more per claim, and still may not get paid. Hospitals spent an average of $57.23 per claim fighting through adjudication in 2023, up 23% in a single year (Premier Inc., 2025).
Then there is prior authorization, which has become its own operational burden. Physicians average 40 prior authorizations a week, consuming 13 hours of physician and staff time, and 40% of practices now employ staff who work exclusively on it (AMA, 2026).
- Eligibility and benefits verified ahead of scheduled visits
- Active coverage, plan type, and effective dates confirmed at source
- Patient financial responsibility identified before the visit, not after
- Prior authorization requirements flagged, submitted and tracked to decision
- Registration and demographic data checked against payer records
- Coordination of benefits and secondary coverage identified upfront
- Referral requirements confirmed where the plan demands them
How it works
What we actually do
We verify ahead of the schedule
Verification runs against upcoming appointments rather than reacting at check-in, so there is time to resolve a coverage problem before the patient is standing at the desk.
Discrepancies come back to your team, clearly
When coverage is inactive, the plan has changed, or the ID does not match, your front desk gets a specific, actionable note — not a raw payer response to interpret.
Authorizations are tracked to a decision
Submitted, followed up, and escalated. Under CMS rule CMS-0057-F, affected payers must decide standard prior authorization requests within seven calendar days from January 2026 and give a specific reason for every denial. We hold them to it.
Patterns get reported, not just handled
If one payer keeps rejecting a particular plan type or a specific registration field keeps causing denials, that shows up in your reporting as a fixable pattern.
Common questions
What practices ask us about this
Does this replace our front desk staff?
No. It supports them. Your team still checks the patient in; we do the verification work behind it and hand back a clear answer rather than a payer portal screenshot.
How far ahead do you verify?
Against the upcoming schedule, with enough lead time to resolve problems before the visit. The exact window is set with you based on how far out your schedule runs.
Do you handle prior authorizations too?
Yes — identifying when one is required, submitting it, following up and tracking it to a decision. This is among the most time-consuming work in a practice and among the most valuable to hand off.
What about patients who arrive same-day?
Same-day and walk-in verification is handled as part of the workflow. Turnaround expectations are agreed during onboarding.
Will patients get a cost estimate?
Patient responsibility is identified during verification so your team can have the conversation up front. Roughly 90% of patients say cost estimates are helpful, but only about a third of providers offer them regularly (Cedar, 2021).
Related services
The rest of the cycle
Find out what your revenue cycle is actually leaving behind.
Request a consultation and a revenue cycle specialist will walk through your denial patterns, A/R aging and payer mix with you. No obligation, and no software to install.