Eligibility Verification & Prior Authorization

Verify Benefits and Eligibility for your Patients in the fastest way possible


How significant the Eligibility Verification and Prior Authorization is ?

Prior authorization refers to the eligibility verification process that allows practices to submit and recoup approved claims to optimize cash flow. Poor prior authorization processes can lead to the exact opposite of what you want – increased denials and decreased revenue. To receive payments for the services rendered, healthcare providers need to verify each patient’s eligibility and benefits before the patient’s visit. Some estimates indicate that as many as 75% of the claims getting denied are on account of the patient not being eligible for the services rendered by the healthcare provider. Unfortunately, it is one of the most neglected processes in the revenue cycle chain.

Patient Eligibility Verification

Receiving Patient Schedule
Verify Insurance Coverage
Contacting Patient, If Required
Updating the Billing System

A Comprehensive Checklist for Eligibility Verification

Health Insurance Carrier Status

Health Insurance Plan Type

Group Numbers

Dependents Covered Under the Plan

Insured Contact Details if any

Covered and non-Covered Services Information


Co-pay Details

Pre-existing Condition Waiting Period if any


Pre-authorization Checks for Service

Plan Limitaions and Exclusions

Prior-Authorization Verification

Prior authorization determination and requirements
Submission of authorization paperwork to insurance
Follow-up on the authorization request
Notification and resolution of rejection of authorization application

5 Steps Eligibility Verification Process Specialized for prior-authorization

Your Well-Being with
iSolve RCM

iSolve RCMs Eligibility verification and prior authorization services offer:

Save Operational Costs

Improve Speed to Care Delivery

Reduce Claim Denials

Reduce Bad Debits and Increase Cash Collections

Focus on Growing your Business

iSolve RCMs Unimpaired Tech

We at iSolve RCM offer our providers the most effective automated workflow to bypass patient eligibility denials. Our services ensure a hassle-free experience for both the providers and their patients. We ensure comprehensive eligibility checks through automation tech prior to services rendered.

Through our system, the provider is immediately informed of pending patient responsibilities, Co-Pay, and other dues. We provide an aggressive check system where all patient’s statuses are verified.

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