Before a patient is ever seen, the outcome of their claim is already being decided. Eligibility and benefits verification confirms a patient's active coverage, and prior authorization secures payer approval for planned services — both completed before the visit, so payment isn't left to chance.
What is Eligibility and Benefits Verification?
To receive payment for services rendered, healthcare providers need to verify each patient's eligibility and benefits before the patient's visit. Industry estimates suggest that as many as 75% of denied claims trace back to a patient simply not being eligible for the service billed — and it remains one of the most neglected steps in the revenue cycle.
Impact of ineffective verification & prior authorization
When eligibility, benefits, and prior authorization aren't confirmed up front, the effects ripple through the entire practice — not just the billing office.
Increased claim denials and avoidable write-offs
Delayed payments and slower cash flow
Extra staff time spent on rework and appeals
Delays in patient access to approved care
Lower patient satisfaction over billing surprises
Full non-payment of claims in worst-case scenarios
Adrotack Healthcare brings you a dedicated team of experts to help accelerate your accounts receivable cycle — confirming patient eligibility and obtaining any necessary prior authorization before the patient walks into the physician's office.
What our team does for every patient encounter
Receive the patient schedule
We pull the upcoming appointment schedule directly from the healthcare provider's office, hospital, or clinic system.
Enter patient demographics
Patient demographic information is captured and entered accurately to prevent downstream claim rejections.
Verify coverage with payers
We confirm benefits with the patient's primary and secondary payers — checking that coverage is valid on the date of service.
Confirm patient responsibility
Benefit options are reviewed to determine copays, coinsurance, and deductibles owed by the patient.
Initiate prior authorization
Where required, we submit prior authorization requests and follow through until approval is obtained for treatment.
Update your systems
Every detail obtained from the payer is logged into your revenue cycle or practice management system — ready before the visit.