Before each appointment, coverage details are verified automatically and the status is added to the patient file — so the team catches coverage problems before the patient arrives, not at the desk.
Typical results
100%
of patients verified before arrival
0
coverage surprises at check-in
Every file
updated with coverage status automatically
Figures reflect typical results for this kind of automation.
The challenge
Eligibility was checked by hand one patient at a time, which was slow and meant coverage gaps were often discovered only at check-in.
Before and after
Time per eligibility check
−70%Coverage issues discovered at check-in per month
−85%Patients verified before the visit
2.9×The automation
Ahead of each visit, an automation submits the patient's insurance details for verification, records the coverage status on the file, and flags any mismatch for the front office.
How it works
- 01
Visit approaches
Ahead of each appointment, the flow picks up the patient's insurance details.
- 02
Automatic verification
Coverage is submitted for verification with no one at the desk lifting a finger.
- 03
Status on the file
The coverage status is recorded directly on the patient file.
- 04
Mismatches flagged
Any gap or mismatch is flagged to the front office immediately.
- 05
Resolved before arrival
The team fixes coverage problems days before the patient walks in.
Starts from
- Insurance details
- Upcoming visit
Delivers
- Coverage status
- Flag issues
The impact
Eligibility checks run about 70% faster, and the team resolves coverage issues well before the appointment.
Questions about this automation
How far ahead of the visit does the check run?
A scheduled job scans upcoming appointments every day, commonly three business days ahead, and submits each patient's insurance details for verification. A second check can run the day before the visit to catch late changes, such as a plan that ended at the start of the month.
Where do the eligibility results come from?
The automation sends the patient's insurer, member number and date of birth to the payer's eligibility service or a clearinghouse, depending on what each insurer supports. The response, including active status and plan details, is recorded on the patient file in the practice management system with the date it was checked.
What happens when coverage doesn't match?
Inactive coverage, a different plan than the one on file, or a missing referral requirement opens a task for the front office with the payer response attached, so the team can contact the patient days before the appointment. Simple automations like this are usually live within days, often starting with the largest insurers.