Eligibility Checking

We can provide eligibility checking of your patients to validate before admitting them whether the insurance plan will cover the services provided. This is key for ABA therapy and mental health billing, as validation is completed timely to assure payment on the backend. Failing to run eligibility can cause claims to be denied by the insurance company. Our process integrates with authorizations management in Miami, Florida to ensure thorough and accurate verification every time.

Why Eligibility Checking Matters

Eligibility checking is an essential step in preventing claim denials and avoiding payment delays. It allows providers to confirm a patient’s insurance coverage before delivering any service, ensuring there are no surprises later. This process also helps patients understand their benefits so they can make informed decisions about their care. By validating insurance coverage early, practices maintain steady cash flow and reduce the risk of unpaid services.

How It Works

Step-by-Step Process for Eligibility Checking

1. Collect Patient Details – Gather demographic and insurance information before admission.
2. Verify Coverage Status – Use secure systems or direct insurer contact to check coverage.
3. Review Service Benefits – Confirm if the services are covered under the patient’s plan.
4. Identify Authorization Requirements – Determine if prior authorization is needed.
5. Share Verified Results – Relay findings to the care team promptly to avoid delays.

Key Benefits of Eligibility Checking

A consistent and accurate eligibility checking process offers several advantages:

• Reduces claim rejections from insurance companies
• Improves accuracy in billing and compliance
• Speeds up reimbursement timelines
• Ensures patients know their coverage before receiving services
• Prevents unexpected financial burdens for patients
• Supports smoother administrative workflows

When Eligibility Checking Makes the Most Difference

Eligibility verification is especially valuable in:

• New patient admissions for specialized care
• High-cost medical or therapy services
• Behavioral health or ABA therapy with strict coverage rules
• Treatments that require prior authorization
• Ongoing care when insurance changes

Strengthening the Revenue Cycle

Incorporating eligibility checking into every intake process helps keep the revenue cycle healthy. It minimizes administrative challenges by preventing disputes, reducing the number of denied claims, and avoiding back-and-forth with insurers. When practices verify eligibility before care begins, they can focus on quality service delivery instead of chasing down payments. Over time, this process strengthens provider-patient trust, as patients appreciate the transparency about their coverage and costs.