Eligibility & Benefits

To receive payments for the services rendered, healthcare providers need to verify each patient’s eligibility and benefits before the patient’s visit. Some estimates indicate that as many as 75% of the claims getting denied are on account of the patient not being eligible for the services rendered by the healthcare provider. Unfortunately, it is one of the most neglected processes in the revenue cycle chain. Ineffective eligibility and benefits verification and/or prior authorization processes can result in increased claim denials, delayed payments, additional effort on rework, delays in patient access to care, decreased patient satisfaction, and non-payment of claims.