Insurance Eligibility Verification Services
We verify insurance coverage, benefits, and authorizations in real time to eliminate errors and improve your revenue cycle performance. Financial certainty for every patient encounter.
Eligibility Performance Benchmarks
Matrix
Industry Average
Revix MD Standard
Verification Response Time
24–48 Hours
Real-Time / < 2 Hours
Data Accuracy Rate
72%
99.4%
Eligibility-Related Denials
24%
< 1.5%
Patient Collection Success
64%
91.2%
What Practices Lose to Verification Gaps
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.
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.
Comprehensive Verification Process
Real-Time Insurance Validation (EDI 270/271 & HETS)
CAQH CORE compliant responses in under 20 seconds. We leverage Medicare HETS for Part A/B status and navigate state-specific MMIS portals for Medicaid requirements across all 50 states.
Forensic Benefit Deep-Dives
We verify remaining deductibles, coverage for specific CPT codes, copays, coinsurance, telehealth billing eligibility, and HSA/FSA balances to support accurate patient responsibility estimates before the visit.
Prior Authorization & Ongoing Monitoring
We identify if a procedure requires pre-authorization and verify that existing authorizations have sufficient remaining units. For active treatment plans, we provide ongoing eligibility monitoring.
Coordination of Benefits & Insurance Discovery
We manage behavioral health carve-out vendors (Optum, Carelon, Evernorth) and our Insurance Discovery service identifies active coverage for patients who erroneously present as self-pay, recovering 5–10% of previously lost revenue.
Eligibility Workflows Built for Modern Payer Requirements
Specialty Expertise
Behavioral health carve-out management plus support for oncology, orthopedics, and primary care.
No Surprises Act
Accurate, real-time benefits to help your practice comply with Good Faith Estimate (GFE) requirements.
EHR-Native Integration
Direct login to SimplePractice, TherapyNotes, Kipu and more. SOC 2 and HIPAA-compliant data security.
Seamless 30-Day Implementation
Diagnostic Audit
7-day review of 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 is verified.
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
FAQs
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 integrate 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 can change frequently. Revix MD rechecks coverage before visits, verifies spend-down or secondary payer issues, and aligns eligibility review with Medicaid billing requirements before claims move forward.
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 30 days, but we can fast-track urgent “AR Rescue” integrations within 7–10 business days, depending on EHR access.