01
Verify before the visit
Organize scheduled patients and verification status so staff can address exceptions before arrival.
PRIVATE PRODUCT CONCEPT
Turn eligibility verification into a reliable pre-visit workflow.
EligibilityCheck helps healthcare teams organize verification work, review returned coverage details, identify missing information, route exceptions, and preserve a timestamped record. Authorized staff stay responsible for every interpretation and patient conversation.
Administrative decision support only. EligibilityCheck does not guarantee coverage, authorization, benefits, patient responsibility, or payment.
THE OPERATIONAL BENEFIT
Know what was checked, what came back, and what needs review.
EligibilityCheck brings the scheduled visit, verification source, returned status, coverage dates, configured plan fields, exceptions, ownership, and review record into one controlled work queue.
Staff can see whether a verification was completed, what information is missing or conflicting, who is responsible, and when the response was reviewed. Leaders gain a structured view of unresolved exceptions.
02
Surface missing details
Place returned coverage information, missing fields, discrepancies, and source details in one review workspace.
03
Route exceptions clearly
Assign unresolved, inactive, ambiguous, or mismatched responses to the right authorized staff member.
04
Preserve the verification trail
Record the source, request and response time, reviewed fields, staff action, and final operational status.
THE ELIGIBILITY WORKBENCH
Organize the response, then let the right person decide.
A useful eligibility workspace connects the request to the returned source, effective dates, configured fields, discrepancies, reviewer, and action.
01 / INTAKESynthetic eligibility request
02 / REVIEW PLANPrepared for authorized review
PROPOSED NEXT STEPCompare and resolve
REVIEW REQUIRED- Source
- Approved transaction or API response
- Evidence
- Returned fields and effective dates
- Open item
- Missing, unmatched, or conflicting details
- Timing
- Verification timestamp and internal cutoff
Illustrative interface using synthetic information. No patient data, financial estimate, or live eligibility response is shown.
REQUEST TO RECORD
A controlled six-step workflow.
Exact steps depend on the organization, source connection, visit type, configured fields, exception rules, and systems of record.
- 01
Receive
Capture the approved appointment and demographic details needed for verification.
- 02
Match
Check that the person, plan, and requested date align with the configured source.
- 03
Request
Send an approved eligibility transaction or API request through a controlled integration.
- 04
Compare
Organize returned status, dates, plan details, and configured fields for review.
- 05
Review
Let authorized staff resolve mismatches, exceptions, and uncertain responses.
- 06
Record
Preserve the source, timestamp, decision, and approved system-of-record update.
A BOUNDED FIRST PILOT
Start with one visit type or verification queue.
Start with one location, visit type, or verification queue, plus representative exceptions and acceptance criteria the organization understands.
FIRST PILOT
What the evaluation can include
- One location, visit type, or eligibility workflow
- Synthetic or properly de-identified evaluation records
- Reviewed fields and exception rules
- Verification and discrepancy checklist
- Authorized front-office or billing decisions
- Agreed baseline and acceptance measures
PRODUCTION BOUNDARIES
What requires separate approval
- Approved access to patient and appointment records
- Authorized eligibility transaction, clearinghouse, or API access
- Secure hosting and applicable business associate agreements
- EHR, practice-management, or scheduling integration
- Current field mapping and organization review rules
- Role-based access and audit retention
MEASURE BEFORE EXPANDING
Measure whether staff get complete answers earlier.
Compare verification time, pre-visit completion, mismatches found, reviewer agreement, exception touches, and timestamped records.
01Minutes spent on each eligibility verification
02Scheduled visits verified before the agreed cutoff
03Missing or mismatched details found before arrival
04Reviewer agreement and correction rate
05Exception touches before documented resolution
06Records with a current timestamped verification trail
RESPONSIBLE OPERATION
The system organizes. Authorized staff decide.
Keep the request, response, timestamp, and configured source connected to the review.
Route ambiguous, incomplete, or conflicting plan details to authorized staff.
Give each person only the records and actions needed for the approved purpose.
Send incomplete, conflicting, urgent, or unsupported cases to qualified review.
BUILD WITH AI GAUR
Choose one eligibility queue worth improving.
We can map the present process, identify the fields and controls, and define a pilot your front-office and billing teams can evaluate.
Discuss an EligibilityCheck pilot Do not submit patient records or protected health information through the public contact form.Questions worth asking.
What does EligibilityCheck provide to front-office and billing teams?
EligibilityCheck organizes the verification request, returned status, coverage dates, configured plan fields, missing or conflicting details, ownership, and review timestamp in one work queue. Staff can see what was checked, what came back, and what needs attention.
Can EligibilityCheck help verify coverage before a scheduled visit?
Yes. A production implementation can send an approved eligibility transaction or API request, organize the returned information, and route exceptions for authorized review before the organization's cutoff. The returned response remains subject to staff interpretation and current payer information.
Can EligibilityCheck surface missing or conflicting information?
Yes. It can compare configured fields, highlight missing data or mismatches, and assign unresolved items to the appropriate staff member. The organization decides which fields and exception rules matter for each workflow.
Can EligibilityCheck connect to an EHR, practice-management system, or clearinghouse?
Yes, when the system provides suitable access and the organization approves the architecture, permissions, security controls, and business agreements. Integrations are scoped separately and begin read-only wherever practical.
What can an EligibilityCheck pilot measure?
Useful measures can include time spent on each verification, visits verified before the agreed cutoff, missing details found before arrival, reviewer agreement, exception touches, and records with a current verification trail.
Can EligibilityCheck calculate the exact patient responsibility or perform prior authorization?
No. Eligibility details do not establish a guaranteed final patient amount, and prior authorization is a separate workflow. EligibilityCheck organizes returned information for review. PriorAuth Navigator addresses authorization work.
Can EligibilityCheck guarantee active coverage or payment?
No. Eligibility responses can change, may be incomplete, and do not guarantee coverage, authorization, medical necessity, benefits, payment, or claim adjudication. Authorized staff must review the returned source and follow the organization's verification process.