Insurance Eligibility Verification Services
We verify insurance coverage, benefits, and authorizations in real time to eliminate errors and improve your revenue cycle performance.
What Practices Lose to Verification Gaps
Eligibility verification is the most critical step in your revenue cycle. Most practices lose 10% to 15% of their monthly revenue because they lack a proactive system to catch mid-month insurance changes or exhausted benefit caps. View MGMA Report
Preventing Patient Balance Surprises
When eligibility is verified after the service is rendered, the practice is forced into a difficult collection cycle. We move your practice from reactive billing to proactive financial counseling. By providing a clear breakdown of co-pays, co-insurance, and remaining deductibles before the appointment, your front desk can collect patient responsibility at the time of service with total confidence.
Eliminating Coverage Gaps
Insurance policies can lapse or change at any time, often without the patient’s knowledge. Our system utilizes Electronic Eligibility Verification (EDI 270/271) to perform instant, automated checks. We re-verify coverage 24 to 48 hours before the scheduled visit to catch last-minute plan terminations or changes in primary/secondary coordination.
Comprehensive Verification Process
Revix MD’s eligibility engine covers every nuance of the payer-patient relationship to ensure your claims are clean before they are even generated.
Real-Time Insurance Validation (EDI 270/271 & HETS)
We bypass phone holds by utilizing secure, automated HIPAA transactions. We ensure CAQH CORE compliance with real-time eligibility responses in under 20 seconds. Our team leverages Medicare HETS to verify Part A/B status and psychiatric care limits. We also navigate state-specific MMIS portals to manage complex Medicaid requirements for multi-state telehealth groups across all 50 states.
Forensic Benefit Deep-Dives
Beyond generic active status, we perform forensic benefit audits. We verify exact remaining deductibles, confirm coverage for specific CPT codes (e.g., 90837 for therapy or 99214 for psychiatry), and track out-of-pocket maximums. We also verify HSA and FSA balances to facilitate immediate point-of-service collections for high-deductible health plans.
Prior Authorization & Ongoing Monitoring
We identify if a procedure requires pre-authorization and verify that existing authorizations have sufficient remaining units. For patients on active treatment plans, such as oncology cycles, physical therapy series, or long-term behavioral health programs, we provide ongoing eligibility monitoring to ensure coverage remains active throughout the course of care.
Coordination of Benefits & Insurance Discovery
Managing secondary and tertiary payers is where manual systems fail. We identify Medicare/Medicaid coordination rules and manage behavioral health “carve-out” vendors (such as Optum, Carelon, and Evernorth). Furthermore, our Insurance Discovery service identifies active coverage for patients who erroneously present as self-pay, typically recovering 5–10% of previously lost revenue.
2026 Standards for Revenue Integrity
In the 2026 regulatory environment, eligibility verification is your primary tool for compliance and specialty-specific growth.
Specialty Expertise
While we excel in behavioral health carve-out management, our team supports high-acuity specialties including oncology, orthopedics, and primary care.
No Surprises Act
We provide accurate, real-time benefits to help your practice comply with Good Faith Estimate (GFE) requirements.
EHR-Native Integration
We log directly into your native platform (SimplePractice, TherapyNotes, Kipu, etc.) and upload verification data directly into the patient chart, maintaining SOC 2 and HIPAA-compliant data security.
Seamless 15-Day Implementation
Diagnostic Audit
A 5-day review of your current verification bottlenecks and denial patterns to identify revenue leaks.
Secure System Sync
Establishing encrypted access to your EHR and setting up automated EDI 270/271 triggers.
Real-Time Go-Live
Our Verification Team begins daily audits of your schedule, ensuring every patient arriving tomorrow is verified by the end of today.
Performance Reporting
Weekly reports showing your reduction in eligibility denials and increase in at-the-door collections.
Don't let your revenue depend on a manual billing strategy
Real-time verification. Proactive collection. Total revenue integrity for every patient encounter.
Frequently Asked Questions
How does eligibility verification differ from prior authorization?
Eligibility confirms the patient has an active policy and identifies their cost-sharing responsibility (deductibles/co-pays). Prior authorization is a separate requirement where the payer must pre-approve a specific service as medically necessary before it is rendered. Revix MD handles the verification of both.
Do you handle Medicare verification through HETS?
Yes. We utilize the HETS 270/271 application to verify Medicare Part A and Part B eligibility, deductible status, and specific benefit limitations in real time.
What is your typical turnaround for urgent same-day verifications?
While we prioritize verifying the schedule 24–48 hours in advance, our team handles urgent, same-day additions in real time, typically providing a full benefit breakdown in under two hours.
Do you have expertise with SimplePractice, TherapyNotes, or Kipu?
Yes. Revix MD is technology-agnostic. We log directly into your existing EHR to document benefits, ensuring your clinical team has financial visibility without needing to check external spreadsheets.
How do you handle Medicaid coverage that changes monthly?
Medicaid eligibility is volatile. We re-verify Medicaid patients on the first of every month and again 24 hours before their appointment to catch spend-down requirements or plan changes.
What's your pricing model per verification or monthly?
We offer flexible pricing models, including per-verification rates for high-volume facilities or as part of a comprehensive percentage-of-collections RCM agreement.
How quickly can you onboard our practice?
Our standard implementation takes 1 week to 15 days, but we can fast-track urgent “AR Rescue” integrations within 7–10 business days, depending on EHR access.