REAL-TIME ELIGIBILITY VERIFICATION

Patient Eligibility Verification That Prevents Revenue Loss

Real-time insurance verification and benefit checking to ensure clean claims, reduce denials, and eliminate payment delays before services are rendered.

Real-time Verification Interface

Live Data
Patient Name
John M. Smith
DOB
05/15/1982
Insurance Provider
Blue Cross Blue Shield
Policy Status
Active ✓
Effective Date
01/01/2024

Coverage Summary

Deductible Met$1,250 / $1,500
Co-payment$30
Co-insurance20%
Out-of-pocket Max$4,500
Eligibility Confirmed
Verified 30 seconds ago
Claim Status
Ready to Submit

Transform Your Patient Intake Process

Comprehensive eligibility verification that impacts every aspect of your revenue cycle

Reduce Claim Denials

Eliminate front-end denials by verifying coverage before services are rendered

Up to 85% reduction in eligibility-related denials

Accelerate Payments

Clean claims with verified eligibility are processed 40% faster by payers

Improve cash flow by reducing AR days by 15-20 days

Increase Collections

Accurate benefit verification ensures proper patient responsibility collection

Increase point-of-service collections by 60-75%

Improve Patient Experience

Transparent cost estimates and clear insurance coverage information

95% patient satisfaction with pre-service financial counseling

Compliance Assurance

HIPAA-compliant verification process with audit trail for every check

100% compliance with payer requirements and regulations

Data Accuracy

Real-time updates from 900+ payers including Medicare and Medicaid

98.7% accuracy rate in coverage verification

5-Step Eligibility Verification Process

A systematic approach to ensure complete coverage verification before service delivery

STEP 01

Patient Registration

Capture demographic and insurance information

Insurance card scanning
Demographic validation
Policy number verification
STEP 02

Real-time Verification

Instant connection to payer systems

Active coverage check
Eligibility status
Effective dates
STEP 03

Benefit Verification

Detailed coverage analysis

Deductible status
Co-pay/Co-insurance
Authorization requirements
STEP 04

Patient Responsibility

Clear financial communication

Out-of-pocket estimates
Payment options
Financial agreements
STEP 05

Documentation

Complete audit trail

Verification records
Patient consents
Regulatory compliance

Live Verification Dashboard

Real-time visibility into your eligibility verification performance

Real-time Verification System

Live updates every 3 seconds

Current Time
0
Verifications Today
2.4s
Avg Response Time

Payer Performance

B
BCBS
2.1s avg
98.5%
Success Rate
U
United
2.8s avg
97.8%
Success Rate
A
Aetna
1.9s avg
99.1%
Success Rate
C
Cigna
3.2s avg
96.4%
Success Rate
M
Medicare
4.5s avg
99.5%
Success Rate

Today's Verification Status

Denial Prevention Impact

With real-time eligibility verification, practices typically prevent:

  • 85% of front-end denials
  • $45-75 per claim in rework costs
  • 15-20 days in AR reductions

Comprehensive Coverage Verification

Support for all major insurance types and government programs

Commercial Insurance

Major Providers

BCBSUnitedHealthAetnaCignaHumana

Verification Features

  • Real-time eligibility
  • Deductible status
  • Co-pay amounts
  • Network status

Government Programs

Major Providers

MedicareMedicaidTRICAREVACHIP

Verification Features

  • Part A/B verification
  • Medi-Medi crossover
  • VA authorization
  • State-specific rules

Exchange/Marketplace

Major Providers

HealthCare.govState exchangesACA plansCatastrophic plans

Verification Features

  • Subsidy verification
  • Metal tier benefits
  • Out-of-pocket tracking
  • Network adequacy

Specialty Coverage

Major Providers

Workers' CompAuto InsuranceLiabilityDisabilitySupplemental

Verification Features

  • Claim liability
  • Attorney representation
  • State fund verification
  • Secondary coverage

Advanced Technology & Seamless Integration

Built for modern healthcare IT infrastructure with enterprise-grade security

System Integration

EMR/EHR Integration

Seamless integration with major electronic health record systems

Compatible With:
EpicCernerAllscriptsNextGenAthenahealth

Practice Management

Direct connection to practice management software

Compatible With:
GE CentricityeClinicalWorksGreenwayMcKesson

Patient Portal

Patient self-service verification through portals

Compatible With:
Patient engagement platformsMobile appsWeb portals

Clearinghouse

Real-time connections through major clearinghouses

Compatible With:
Change HealthcareAvailityWaystarSSIZirMed

Enterprise Security & Compliance

HIPAA Compliant

256-bit encryption & secure data handling

SOC 2 Certified

Enterprise-grade security protocols

99.9% Uptime

Redundant systems & 24/7 monitoring

Audit Trail

Complete audit trail for compliance

Measurable Results & Financial Impact

Data-driven outcomes from implementing real-time eligibility verification

Performance Improvement

Claim Denials84.9% reduction
Before
18.5%
After
2.8%
Clean Claim Rate19.3% improvement
Before
81.5%
After
97.2%
AR Days49.6% faster
Before
45.2days
After
22.8days
Point-of-Service Collections122.9% increase
Before
35%
After
78%
Patient Satisfaction30.6% improvement
Before
72%
After
94%
Staff Productivity41.5% increase
Before
65%
After
92%

Annual Financial Impact*

Denial Reduction

Annual savings from reduced claim rework

$285,000

Faster Payments

Improved cash flow from reduced AR days

$420,000

Increased Collections

Additional revenue from improved collections

$175,000

Staff Efficiency

Savings from reduced manual verification

$95,000
Total Annual Impact
$975,000

*Based on average 50-physician practice

Frequently Asked Questions

Common questions about eligibility verification services

QHow accurate is real-time eligibility verification?

A

Our system maintains a 98.7% accuracy rate by connecting directly to payer systems and using multiple verification sources including clearinghouses, payer portals, and direct connections.

QWhat insurance payers do you support?

A

We support all major commercial payers (BCBS, United, Aetna, Cigna, Humana), government programs (Medicare, Medicaid, TRICARE), and 900+ regional and specialty plans.

QHow quickly can we implement your solution?

A

Most implementations are completed in 2-4 weeks, depending on your EMR/PMS integration requirements. Our team handles the entire setup process with minimal disruption.

QIs the system HIPAA compliant?

A

Yes, we are fully HIPAA compliant with SOC 2 certification. All data is encrypted in transit and at rest, with complete audit trails and role-based access controls.

QCan patients verify their own eligibility?

A

Yes, we offer patient portal integration that allows patients to verify their insurance coverage before appointments, reducing front-desk workload and improving patient experience.

QWhat happens when insurance verification fails?

A

Our system provides detailed error codes and recommended actions. We also offer concierge follow-up services to resolve complex verification issues on your behalf.

ELIGIBILITY VERIFICATION

Ready to Eliminate Eligibility-Related Denials?

Schedule a live demo to see how real-time verification can transform your patient intake process and boost your revenue cycle performance.

Email Us
info@upscalealliance.com
Call Us
+1 (917) 947-0117
Response Time
Within 2 Business Hours