Eligibility Verification
Don’t Let Denials Start at the Front Desk
Eligibility verification is one of the most overlooked—yet most critical—steps in the revenue cycle. It’s also one of the top causes of denied or delayed claims. Too many providers are delivering services without knowing if the patient’s insurance will even cover the visit. By the time the claim is denied, it’s too late—and everyone loses.
When Is Eligibility Required?
Eligibility should be verified before:
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Every new patient visit
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Any recurring services at the start of a new benefit period
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High-cost procedures like imaging, testing, or outpatient surgeries
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Ongoing care like ABA therapy, physical therapy, and behavioral health services—especially when authorizations or visit limits apply
These checks are necessary not just for coverage, but for specifics: copays, deductibles, plan exclusions, and whether the provider is in-network. Missing any of these can lead to immediate denials or uncollectible balances.
No Verification = No Leverage
When eligibility isn’t confirmed ahead of time, providers are often left without recourse. The claim gets denied, and you're stuck:
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You can’t bill insurance.
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You’ve already delivered the service.
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You’ve used valuable staff time and resources.
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Now, the balance falls to the patient—who may not be able (or willing) to pay.
When a patient receives services without active coverage and no prior verification was done, they become financially responsible in most cases. But that doesn’t make it easier for your office to collect or manage the fallout.
We Handle It, So You Don’t Have To
At MBM, we run real-time eligibility checks prior to the patient’s appointment, including benefit verification and authorization status when required. We can coordinate with your front desk, operate directly within your EMR, or provide reports to your team—whatever fits your workflow.
This proactive step alone reduces eligibility-related denials by 40% or more and improves overall reimbursement timelines.
If your team doesn’t have the time or resources to verify eligibility consistently, we do. And we do it right.