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ELIGIBILITY VERIFICATION SERVICES

Verify Today.

A Smoother Tomorrow.

At RCM MD Care, we provide accurate and real-time eligibility verification services to ensure your patients are eligible, covered, and informed before their visit. By verifying insurance benefits, coverage details, and patient responsibilities upfront, we help you reduce claim denials, improve collections, and deliver a better patient experience.

Reduce Claim Denials

Save Time

Improve Experience

Increase Revenue

OUR ELIGIBILITY VERIFICATION SERVICES

Complete Insurance Checks for a Hassle-Free Visit

Insurance Eligibility Verification

Real-time verification of patient eligibility and plan status to ensure active coverage.

Benefit Details Review

Detailed review of covered services, limitations, and exclusions for accurate patient communication.

Deductible & OOP Validation

Check remaining deductibles, co-pays, and out-of-pocket amounts before the visit.

Authorization Check

Identify if prior authorization is required for scheduled services.

Plan Effective Dates

Confirm plan effective and termination dates to avoid billing issues.

WHY ELIGIBILITY VERIFICATION MATTERS

Prevent Surprises. Build Trust.

Verifying insurance eligibility before the patient’s visit helps you avoid claim denials, ensure accurate billing, and provide clear financial expectations. It not only protects your revenue but also creates a smoother, more transparent experience for your patients.

Fewer Claim Denials

Submit clean claims with accurate information.

Stronger Cash Flow

Reduce write-offs and delays.

Better Patient Satisfaction

Patients know benefits and costs upfront.

More Efficient Operations

Staff can focus on care, not coverage.

OUR PROCESS

A Simple & Reliable Eligibility Verification Process

Step 01 Patient Information

We collect patient demographics and insurance details.

Step 02 Real-Time Verification

We verify eligibility, plan status, and benefit details through payer portals.

Step 03 Benefits Analysis

We review coverage, deductibles, co-pays, OOP amounts, and limits.

Step 04 Authorization Check

We confirm if prior authorization is required for scheduled services.

Step 05 Patient Communication

We provide clear benefit information to your team and/or patients.

WE WORK WITH ALL MAJOR PAYERS

Insurance Providers We Support

BlueCross BlueShield

aetna

Cigna

UnitedHealthcare

Humana

Medicare

Medicaid

FREQUENTLY ASKED QUESTIONS

Why is eligibility verification important?

Verifying patient eligibility prior to services prevents claim rejections, informs patients of their exact copays and deductibles, and ensures timely reimbursement.

What information do you verify?

We check active coverage dates, primary and secondary insurance status, copays, deductibles, coinsurance, out-of-pocket maximums, covered benefits, and authorization requirements.

How do you verify insurance eligibility?

We use real-time EDI 270/271 electronic portals, automated clearinghouse systems, and direct phone calls to payer representatives when complex verification is required.

Do you handle Medicare and Medicaid verification?

Yes, we regularly verify Medicare Part A, B, Advantage plans, and state-specific Medicaid programs including HMOs and MCOs.

Can you verify secondary insurance?

Yes, we confirm coordination of benefits (COB) and verify secondary as well as tertiary coverage details to ensure accurate sequential billing.

How quickly can you provide verification results?

Most electronic verifications are provided within minutes, while comprehensive phone verifications for scheduled procedures are delivered within 24 hours.

Ready to Verify Patient Eligibility?

Partner with RCM MD Care for accurate, real-time insurance verification and a smoother revenue cycle.