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Stop denials before they start
Catch carve-outs and member ID errors before the claim goes out, not after it comes back denied
A denial is usually an intake error in disguise
Registration and eligibility errors are a top cause of denied claims. Most can be caught before the claim is filed
of claims denied on first submission
of denials trace to incomplete or inaccurate registration data
of denials are potentially avoidable
to fight a single denied claim
Fix it at the front end
Check the right things before submission: the carve-out, the member ID, the plan as it stands today
Carve-outs caught before the claim goes out
Benefits returned for the service and setting, not just "active." Carve-out rules applied so the claim goes to the right place the first time
Member ID errors recovered, not resubmitted
A mistyped ID or wrong plan stops a covered patient. Discovery finds coverage from a name, date of birth and state. Verify the match before it reaches the claim
Coverage rechecked before the visit
Plans change mid-year. Recheck on a cadence tied to upcoming appointments and flag changes while staff can still act. Automatic, so rechecks do not add staff work
Where remittance data is available, each verification is compared with the adjudicated claim. Recurring errors by payer and benefit type become rule fixes. Track your eligibility-related denials before and after, on the same plans and services
"...a better claim submission process, with fewer rejections related to up-front eligibility and cost-sharing discrepancies."
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"By reducing manual workflows and improving the accuracy of our insurance verifications, we've enhanced patient conversion rates, improved operational efficiency, and reduced our claim denial rate."
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FAQ
Find where denials start
Bring your top denial reasons and your hardest plans. We will show you which ones are caught before submission