Insurance Eligibility Verification Services

Is proper insurance eligibility becoming an administrative burden for you? Get the best insurance eligibility verification services you’ve dreamed of. We resolve healthcare facilities’ financial issues and make them a thing of the past!

Massachusetts’s Most Trusted Patient’s Eligibility Verification Services At Your Doorstep

Insurance eligibility verification is a building block to a successful RCM (Revenue Cycle Management) process and financial stability. An error may cost you a big financial setback if appropriate measures are not taken. A healthcare practice cannot afford such losses in cash flow. Right steps are necessary to improve provider’s revenue and minimizing denials or rejection of insurance claims.

Medheave’s staff comprises industry’s seasoned medical billing professionals with years of experience. We reduce billing errors by accurately determining the financial responsibilities of patients, so you can provide medical care without worrying about not getting paid. Start your journey towards greatness by choosing our robust system of verifying patient’s eligibility checks. Transition to the world of possibilities!

Our Comprehensive Insurance Eligibility Verification Services Include

Real-Time Insurance Eligibility Verification

Instantly confirm patient coverage through integrated systems and payer portals to ensure faster check-ins, smoother workflows, and fewer claim denials.

Verification of Benefits (VOB)

Access detailed benefit breakdowns, including copays, deductibles, coinsurance, out-of-pocket maximums, and plan limits — ensuring accurate billing and preventing surprise patient charges.

Prior Authorization Alerts

Automatically flag services requiring pre-authorization to reduce claim rejections, speed up approvals, and improve patient satisfaction from day one.

Secondary & Tertiary Insurance Checks

Verify all layers of patient coverage — including secondary and tertiary plans — to ensure complete reimbursement and minimize claim denials due to coordination of benefits.

Patient Responsibility Estimation

Accurately estimate the patient's out-of-pocket costs before service to improve transparency, reduce billing disputes, and support faster collections.

Detailed Policy & Plan Information

Retrieve real-time policy details including plan type (HMO, PPO, Medicare Advantage, etc.), group number, effective/termination dates, coverage rules, and limitations.

Out-of-Network Coverage Validation

Identify and validate out-of-network benefits, including co-insurance rates and prior approval requirements, helping manage patient expectations and reduce revenue loss.

Medicare/Medicaid Eligibility Checks

Confirm active enrollment and coverage status for Medicare and Medicaid beneficiaries to ensure compliance with federal/state billing guidelines.

Plan Tier and Network Matching

Match patients to the correct plan tier (e.g., Bronze, Silver, Gold) and confirm if your providers are in-network — avoiding claim denials due to out-of-network billing.

EDI Integration for Automated Eligibility Checks

Connect directly to payers through Electronic Data Interchange (EDI) to automate eligibility checks, reduce manual errors, and ensure faster, real-time updates.

Termed Policy & Inactive Coverage Alerts

Identify policies that are inactive, expired, or recently terminated, helping you avoid seeing non-covered patients and eliminating delays in reimbursement.

Integration with Scheduling & EHR Systems

Embed eligibility checks directly into your scheduling workflows and EHR platforms, enabling real-time insurance verification at the time of booking.

What We Offer in Our Eligibility
Verification Process

Patient Demographic and Document Verification

We begin with collecting and validating:

Patient name, DOB, address 
Policy and group number
Insurance provider details

This proactive document check avoids bottlenecks later in the billing cycle.

Insurance Benefits Verification & Coverage Analysis

Our experts validate insurance coverage specifics, including:

Policy status (active/inactive)  
Service-level coverage 
Co-payments, deductibles, and pre-authorization requirements

We ensure insurance benefits verification is completed before services are rendered.

Real-Time Insurance Eligibility Checks

Every patient’s eligibility is verified using fast, secure systems to confirm they qualify for the scheduled services — improving patient care and provider confidence.

Automated Patient Follow-Up

We contact patients when insurance details are missing or unclear before claim submissions, e.g., policy number, etc, ensuring they stay informed and your practice avoids delays.

Claims Denial Management & Appeal Filing

Our billing team handles claims denial management with proactive appeal filing — saving your staff from paperwork and accelerating reimbursements.

Insurance Denial Appeal

Filing denial appeals is a task that’s a headache for medical practitioners. At MedHeave we let you off the hook by filing the denial appeal in case of such instances. Our billing experts will ensure you don’t have to go through the lengthy paperwork and financial headaches. We will take care of this delicate work by having a strong and round the clock follow-up.

Why Outsource Insurance Eligibility Verification is Essential For Your Practice?

Insurance eligibility verification services are the best solution for managing your RCM and patient responsibility. We know it’s hard to keep up with everything, especially verifying patient eligibility. This is where you either make or break in terms of revenue reimbursement. A small miscalculation results in bad debts, ultimately putting your business at the risk of having severe financial loss.

A need for experienced and reputable service that’ll do all sorts of patient’s verification and eligibility checks is increasing day by day. Hire us and minimize the damage to your revenue stream. MedHeave is a medical billing company and a renowned name in healthcare services based in Massachusetts and has proven itself as a benchmark of excellence year after year. We’ll ensure your practice flourish and the continuous cycle of revenue generation stays active.

Benefits of Our Insurance Eligibility Verification Services

Prompt information of patient’s coverage
No out-of-pocket costs shocks for patients
Improved financial health & minimum revenue leakages
Easy integration with Electronic Health Records
Suitable for all specialties, Internal Medicine, Mental Health, Urgent Care, etc

Optimize Your Revenue Without Suffering From Denials

Our RCM staff offers swift verification of benefits with a single click, comprehensively checking details like member ID, effective dates, service provider details via phone calls and emails for quick results.