Front end
Insurance eligibility verification staff who check coverage before the visit
Insurance eligibility verification staff from OffshoreMeds check each patient’s coverage and benefits before the visit, track whether the service needs a prior authorization and estimate what the patient will owe, working in your practice management system and payer portals. A coverage problem found before the visit can be fixed before a claim is ever sent. One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information.
Published by OffshoreMeds. Facts last checked October 9, 2026. How we check our numbers.
The work
What gets checked before the visit
- Active coverage: the plan is in force on the date of service and the patient’s details match the payer’s record.
- Benefits: what the plan covers for the planned service, and the copay, coinsurance and deductible that apply.
- Authorization: whether the service needs a prior authorization, and whether one is already on file. Requests go to prior authorization staff.
- Patient cost estimate: what the patient is likely to owe, so your front desk can tell them before the visit.
These checks run in payer portals such as Availity and in your practice management system, under your access controls, ahead of the scheduled visit.
Most of this checking is already electronic on the plan side. In the 2025 CAQH Index, medical plan adoption of fully electronic eligibility and benefit verification was 96%, against 40% for prior authorization. Prior authorization is far less automated; see how prior authorization staff handle it.
Revenue impact
Why front-end checks matter for denials
MGMA Stat reports first-submission denials of 7-8% over the past four years, and AAFP calls a rate below 5% more desirable. A denial caused by coverage or a missing authorization costs staff time twice: once to submit and again to appeal. Checking before the visit reduces that cause.
Denials that still come back go to the denial management team, and coding errors are caught by the medical coding team.
Cost
What an eligibility verification seat costs
A seat costs $1,500 to $2,000 per month. Prices are indicative until your written quote confirms the exact fee. Practices in Puerto Rico can read about Puerto Rico medical billing on the same rules.
The terms behind each seat
One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information. Clinical decisions stay with your US-licensed providers. See all OffshoreMeds services.
Related guides
- Offshore medical coding staff
ICD-10, CPT and HCC coders working in your EHR, audited daily against a published accuracy standard.
- Denial management staff
Appeals, A/R follow-up and root-cause work, measured against published denial-rate benchmarks.
- Prior authorization staff
Staff who prepare, submit and track prior authorizations, with the clinical line kept where it belongs.
- Puerto Rico medical billing
Same HIPAA rules as the mainland, heavy Medicare Advantage, and what the offshore checks mean for Puerto Rico practices.
- Timely filing limits for medical claims
The federal caps, examples from Cigna, Aetna, Texas Medicaid and Illinois Medicaid, and how to find and track the limit that applies.
- Prior authorization timeframes (CMS rule)
Which payers the CMS rule covers, the 72-hour and 7-day timeframes, what it excludes and the dates that matter.
- OHIP stale-dated claims and error reports
The Ministry's three-month rule, the reports after each submission, the monthly cut-off and how to work rejected claims.
Get Started
Book a free 30-minute call.
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Please keep patient information out of the booking notes. A Business Associate Agreement is signed before anyone touches protected health information. See how this site handles your details in the privacy policy.