Insurance eligibility verification services
We read the fine print on every eligibility plan, so nobody in your office has to squint at a benefits page again.
Active insurance does not guarantee a payable claim. A patient may have valid coverage, yet the service could be excluded, carved out to a separate vendor, prior authorization may be required, the provider may be out of network, or a referral may be needed. Checking only whether a policy is active can leave these issues undetected, leading to denials, unexpected patient balances, and delayed reimbursement.
Eligibility verification specialists review each patient’s coverage before the appointment. They confirm effective dates and provider participation while checking referral and prior authorization requirements. Direct referrals are verified in real time, while standard eligibility requests are completed the same day. This helps identify coverage issues early, before they turn into claim problems.
Our operational footprint
These aren't aspirational targets.
These metrics are what we deliver, consistently, across all practices and specialties we work with.
24-hour
advance verification
Real-time verification
on direct referrals
Two-checkpoint
verification
All major
payer types verified
“Two active plans” is not a billing strategy. You can’t keep two payers on standby and just pick your favorite.
Two active insurance plans can make a claim anything but simple. Primary and secondary coverage may follow different rules, and eligibility information does not always make the billing order clear. A plan can show as active while questions remain about which payer should be billed first, what the secondary plan requires, or whether another payer belongs in the billing sequence.
Eligibility verification specialists review coordination of benefits across primary, secondary, and tertiary plans before claim submission. They confirm the correct billing order and review the applicable requirements for Commercial, Medicaid, Medicare, and Medicare Advantage plans. When electronic information is incomplete, they contact the payer directly to verify the details instead of making assumptions. With the payer sequence established upfront, claims can move through the right billing channel without unnecessary rework or delays.
Where revenue slips
Some claims lose the fight, and others never make it to the ring, by the grace of someone’s reliable biller.
Lapsed coverage
Coverage can change or become inactive, and the practice may not know until eligibility is checked again. Eligibility verification specialists check coverage before each appointment and flag inactive plans early, so a lapsed plan does not make its way into the claim.
Wrong payer first
Two active plans can still create confusion over who pays first. Our specialists review coordination of benefits, confirm the correct payer order, and help ensure claims go to the right payer instead of coming back unpaid.
Missing authorization
A missing prior authorization or required referral can lead to a denial when the payer requires it. Requirements vary by payer and plan, so our team checks for both before the appointment whenever possible, rather than waiting until the service is rendered.
Portal lag
Payer portals do not always show complete or up-to-date information. A plan may appear active electronically while important details still need confirmation. When the information does not line up, eligibility verification specialists contact the payer directly to verify the coverage.
MedHeave verifies coordination of benefits across primary, secondary, and tertiary plans before submission. We confirm the correct billing order and check the rules for Commercial, Medicaid, Medicare, and Medicare Advantage plans. When electronic information is incomplete, we contact the payer directly to verify the details rather than making assumptions.
Our services
An eligibility check that stops at active is basically small talk. We go for the whole conversation.
Eligibility verification is where billing starts with the right information. A thorough check gives the practice a clearer picture of the patient’s coverage before services are provided. Early follow-up helps resolve questions before they turn into claim issues, rework, or payment delays.
Coverage and benefits verification
We confirm coverage dates, plan type, and provider participation, along with applicable deductibles, copayments, coinsurance, and the patient’s remaining out-of-pocket maximum. This gives our billing team a clearer picture of the patient’s coverage before the visit.
Authorization and referral checks
Our authorization team confirms whether a service requires prior authorization or a referral before the appointment. They also check applicable visit limits and other plan requirements that could affect coverage and lead to a denial.
Coordination of benefits
When a patient has multiple insurance plans, our billing team confirms which payer should be billed first. They also verify coordination of benefits with the payer when needed, helping ensure claims follow the correct billing order from the start.
Medicare and Medicare Advantage verification
Medicare and Medicare Advantage plans can have different coverage and administrative requirements. Eligibility verification specialists review each plan according to its applicable rules, so our billing team has accurate information before billing.
Real-time and same-day turnaround
Direct referrals are verified in real time when needed, while standard eligibility requests are completed the same day. Eligibility is also rechecked before billing when necessary to catch coverage changes.
Denial-risk tracking and follow-up
When an eligibility issue puts a claim at risk, our eligibility verification team tracks it through resolution and follows up as needed. This helps address unresolved issues before they contribute to avoidable denials or filing delays.
Calculate your revenue loss
A calculator will not fix a denial, but it makes ignoring the problem a lot less comfortable.
Fill in your details and click Calculate now to see your estimate.
We have verified eligibility for specialties most billing companies pretend do not exist.
Eligibility rules are not the same across specialties, and a one-size-fits-all verification process can miss the details that affect coverage and billing. Our team understands the payer requirements and coverage nuances that vary by specialty, so eligibility is verified with the right context from the start.
Behavioral health
In behavioral health, missing eligibility or session tracking can cost several visits, not just one. We stay ahead of authorization limits, benefit caps, telehealth rules, and co-pay terms so billing stays steady through care.
Podiatry
For podiatry billing, we make sure modifiers like 25 and RT/LT are accurate, services align with global periods and payer edits, and orthotics always meet payer-specific authorization and DME requirements before claims go out.
Urgent care
We handle urgent care billing across walk-ins, diagnostics, and procedures. From there, we track payor coding rules, facility contracts, prior authorizations, and eligibility checks so claims never get delayed, cut, or denied.
Orthopedic
We handle orthopedic billing, making sure procedures get authorized upfront and modifiers like LT/RT and bilateral get applied well. Surgical cases with implants are coded and billed the way payers actually expect for payment.
Cardiology
Cardiology billing often triggers NCCI edit denials, bundling issues, and global period violations when E/M services and procedures are billed together. We manage coding and modifier logic to reduce denials and boost payments.
DME
DME billing is handled by aligning orders, documentation, and delivery timelines with payer rules. We apply HCPCS coding, manage capped rentals, and enforce refill limits so claims are never denied for missing paperwork today.
Pediatrics
In pediatrics, we handle well visits and immunizations, making sure vaccine administration and VFC eligibility are correct. Age-based coding stays accurate as well, so nothing gets missed, underbilled, or delayed at any visit.
Anesthesia
The accuracy of anesthesia billing depends on capturing start and stop times correctly. We ensure precise time capture, apply base units and modifiers, and handle medical direction & concurrency so each unit is billed right.
Don’t see your specialty? We likely work in it.
Our process
Our process is not clever. It is just written down and followed every time, which turns out to be rare.
Request comes in
A verification request comes from your office or through the established referral workflow. The team reviews the request and queues it for verification, so the information is ready to be checked.
Coverage gets verified
The team verifies eligibility ahead of the appointment whenever possible. They confirm the plan, coverage dates, provider participation, and applicable authorization or referral requirements. Service-specific coverage is reviewed when required.
Front desk gets the answer
Verification results are made available to your front desk before the patient arrives. If details such as the member ID or patient information need attention, our team flags them so they can be corrected before check-in.
Coverage gets checked again
Eligibility can change between the appointment and claim submission. The team rechecks coverage when the claim is being prepared to catch changes or unresolved issues before the claim goes out.
Follow-up until resolved
When an eligibility issue puts a claim at risk, our team tracks the issue and follows up as needed. The goal is to resolve coverage questions before they turn into avoidable claim problems or filing delays.
We didn't write these case studies to brag.
Okay, maybe a little.
Experienced across 40+ EHRs. We work natively within your system and never route patient data through third-party tools.
Why MedHeave
We are not smarter than other billing companies. We just have a personal problem with the word “probably”.
Two checkpoints, not one
Coverage can change after an appointment, so one eligibility check may not tell the whole story. Our team verifies coverage before the appointment and checks it again when the claim is prepared, helping catch changes before they create avoidable claim problems.
Specialty-specific, not templated
Eligibility requirements vary by specialty, service, and health plan. Our team considers the coverage and authorization requirements relevant to your practice instead of forcing every verification request through the same generic checklist.
Direct payer contact when portals fall short
Electronic eligibility information can be incomplete, unclear, or inconsistent. When the available information does not provide a clear answer, we contact the payer directly and confirm the coverage details with a live representative.
Denial-risk tracking through resolution
An eligibility issue does not become less important just because it was flagged. When a potential problem puts a claim at risk, our specialists track it, follow up as needed, and work toward resolution.
FAQs
Questions providers like you often ask us
How far in advance do you verify eligibility?
Most requests get verified 24 hours before the scheduled appointment. Direct referrals are checked in real time. For same-day appointments, verification starts immediately, and the office is told upfront if the payer needs extra time.
What happens if a patient's coverage has lapsed?
The front desk gets notified before the appointment, so the practice can decide next steps, whether that means confirming updated coverage, rescheduling, or moving to self-pay.
Do you verify secondary and tertiary insurance too?
We focus on primary coverage but verify secondary and tertiary insurance as well if the provider wants us to do so.
Is Medicare Advantage verified the same way as traditional Medicare?
What if a payer does not offer electronic verification?
Do you verify eligibility for every specialty the same way?
Not always. Which services get verified depends on the provider’s requirements and the specialty, so each practice gets the checks it actually needs rather than one fixed checklist.
What happens if a portal shows active coverage but the claim still gets denied?
We follow up directly with the payer and start corrective action right away, which may include reprocessing or resubmission before an appeal is ever needed.
What if a new patient's coverage has not been activated yet in the payer's system?
We notify the provider’s office right away. The patient then contacts their insurance company to get the coverage updated in the payer’s system.
Residency trained you for 24-hour shifts.
Not for arguing with a 24-year-old prior auth reviewer, barely out of training.
You trained to treat patients, not argue with payers about coverage. Leave it to us to make the calls on your behalf, stay on the line until a live rep answers, and confirm coverage before the appointment.
