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For healthcare providers and practice managers, our free audit / consultation request form is the simplest way to connect with our team. Whether you have questions about our services, need clarification on specific offerings, or would like to explore customized solutions for your practice. Please complete the form below, and our team will review your inquiry and contact you to schedule a consultation. Please feel free to share any inquiries, concerns, or details you would like us to review—nothing is too small or too complex. Once submitted, our specialist team will come back to you and schedule a dedicated consultation at your convenience. We are committed to supporting you, addressing your questions with clarity, and ensuring you feel fully informed and confident moving forward.

info@caremedox.com

(607) 225 5002

30 Days Free Revenue Audit

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Advance Eligibility Verification Services

Verify Coverage Up Front
Prevent Denials
Protect Your Revenue

At CareMedox, we know that one of the most critical steps in your revenue cycle begins before a patient even receives care. With our Advance Eligibility Verification Services, we make sure your patients' insurance coverage, benefits and financial responsibilities are confirmed in advance—so you can minimise surprises, reduce denials and maximise clean claims.

95%+
Verification Accuracy
56%
Fewer Denials
24-48h
Pre-Service Verification

Why Advance Eligibility Verification Matters?

Prevent Claim Denials Before They Happen

Verifying eligibility ahead of service helps avoid key issues like inactive coverage, missing benefits or unmet pre-authorisations.

Improve Cash-Flow and Collections

When coverage and financial responsibility are confirmed early, you submit cleaner claims and reduce payment delays.

Enhance Patient Experience

Patients appreciate knowing their coverage and out-of-pocket costs up front rather than being surprised later.

Reduce Administrative Burden

By outsourcing this front-end verification, your team can focus on clinical operations while our experts handle insurance checks and benefits clarifications.

Stay Compliant & Accurate

The insurance landscape evolves rapidly; we keep on top of plan changes, payer rules, authorisations and benefit limitations so you don't have to.

Our RCM Services Portfolio

Here are the key components of our RCM offering

01

Pre-Service Coverage Check

We proactively verify the patient’s insurance plan status, policy effective date, termination date, network participation, scope of coverage (professional vs institutional), and whether the planned services are included.

02

Benefit & Financial Responsibility Review

We evaluate patient cost-sharing obligations—deductibles, copays, coinsurance, out-of-pocket maximums—and identify any gaps in coverage or services excluded by the payer.

03

Coordination of Benefits (COB)

For patients with multiple insurance plans, we verify primary vs secondary payer roles, payment order, and benefit interplay to avoid billing confusion and delayed payments.

04

Prior Authorisation & Referral Verification

We check if the upcoming service requires authorisation or referral per the patient’s plan, and confirm whether the authorisation has been obtained or is pending—reducing the risk of denial based on authorisation errors.

05

Patient Notification & Financial Counselling

Once verification is complete, we can generate a summary of the patient’s coverage and approximate financial responsibility and communicate with your team or directly with the patient (as you prefer) so there are no bill-surprise moments.

06

Documentation & Reporting

Our verification process is fully documented—date/time of verification, payer summary, patient cost-sharing, authorisation status—and we provide you with clear reports so your billing and front-desk teams are aligned.

How the Process Works — Seamless & Integrated

On-boarding & Workflow Setup

We analyse your current registration/verify processes, identify gaps (e.g., last-minute checks), and tailor our verification workflow for your practice.

1

Integration & Data Capture

We integrate with your practice management or EMR system, define data capture fields, set up verification triggers (e.g., at scheduling, 48h before service).

2

Live Verification Execution

Our team conducts the checks, obtains plan details, identifies risks or gaps, logs results, and flags accounts needing attention.

3

Communication & Follow-Through

Verified information is shared with your staff (or patient) and next steps (e.g., collect copay prior, schedule authorisation) are triggered.

4

Monitoring & Optimisation

We monitor metrics such as verification completion rate, number of uncovered services identified, reduction in denials, and refine process over time.

5

What You Gain

Fewer claim rejections or denials due to eligibility issues

Faster submission of 'clean claims' with higher first-pass acceptance

Better patient satisfaction because coverage is clear up front

Reduced time spent by your staff on chasing missing coverage

Stronger cash flow because fewer surprises = fewer delays

Is This Right for Your Practice?

Whether you are a small clinic, a multi-specialty group or a large institutional provider, if you're looking to reduce billing risk, improve front-end registration accuracy, and strengthen your revenue cycle from the very first touchpoint — then our Advance Eligibility Verification Service is for you.

Let's work together to turn verification into a strategic advantage rather than an administrative burden. Contact us today to discuss how we can implement this service for your practice.

Frequently Asked Questions

Ideally, at scheduling or prior to the patient's appointment—having verification completed 24-48h before service helps catch issues early and allows time for scheduling adjustments or patient counselling.
We flag the issue for your team, assist in identifying alternative coverage if available, inform the patient's financial responsibility, and help you decide whether to proceed, delay or renegotiate.
Yes — our verification covers all types of service settings, whether physician office (professional) or facility/institutional billing.
We work closely with you to align our verification triggers (scheduling, check-in, pre-procedure) with your workflows. Verified data is shared in a format your team uses and we provide training/support to ensure smooth adoption.