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Eligibility & benefits verification

Verify before the visit.
Eliminate denials at the source.

Eligibility errors are the #1 preventable source of claim denials. ImmediCare verifies every patient's insurance coverage, co-pays, deductibles, and authorisation requirements before the appointment — so claims submit clean on day one.

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Eligibility & benefits verification
#1
Cause of preventable claim denials — eligibility errors
30%
Of denials stem from eligibility and coverage issues (MGMA)
24–48hrs
Typical window to verify eligibility before an appointment
98%
Clean claim rate when eligibility is verified pre-visit
Why eligibility verification is non-negotiable in 2026

Why eligibility verification is non-negotiable in 2026

Insurance coverage changes constantly. Patients change plans, lose employer coverage, hit deductibles mid-year, and let COBRA lapse. Payer rules around authorisation requirements, co-pay amounts, and covered services shift with every contract cycle. If your practice bills based on outdated coverage information, the claim gets denied — and reworking it costs $28–32 and days of administrative time. Worse, many practices don't catch eligibility denials until 30–45 days after the visit, by which point the patient relationship is awkward and recovery is complicated. ImmediCare's eligibility team verifies coverage for every scheduled patient — typically 24–48 hours before the appointment.

Pre-visit eligibility check

Coverage verified for every scheduled patient before the appointment, not after.

Benefits breakdown

Co-pay, deductible, co-insurance, and out-of-pocket maximum confirmed per payer and plan.

Authorisation requirements

Prior authorisation needs identified and flagged before services are rendered.

Secondary coverage coordination

Secondary and tertiary insurance identified and documented for accurate coordination of benefits.

Same-day verification

Urgent verification for walk-in patients and same-day appointments.

Eligibility denial prevention

Systematic pre-visit verification that eliminates the most common preventable denial category.

Common questions

Eligibility & benefits verification FAQs

How far in advance do you verify eligibility?
We verify 24–48 hours before scheduled appointments for routine visits, and same-day for urgent or walk-in situations.
What if a patient's coverage has lapsed?
We notify your front desk immediately so they can confirm self-pay terms or updated insurance information before the appointment.
Do you handle prior authorisation too?
Eligibility verification confirms whether authorisation is required. Full prior authorisation management is available as a separate service — contact us for details.

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