Insurance Verification
Eligibility & Benefits Verification
Avoid front-end eligibility rejections entirely. We audit insurance coverage status, copay requirements, and deductibles before your patients walk through the clinic door.
Service Overview
Avera Technologies secures your reimbursement workflows by executing patient eligibility and benefit verification. Our dedicated team checks patient schedules 3 to 5 days in advance, directly contacting commercial and government payers. We extract exact details about active policies, coordination of benefits (COB), lifetime limits, and required pre-authorizations. This ensures your practice can collect correct patient copays at the time of service, decreasing bad debt and front-end claim rejections.
Key Verification Features We Offer
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Active Coverage Audits
Ensuring primary/secondary policies are active and that the patient has not exceeded their coverage boundaries.
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Copay & Deductible Checks
Calculating remaining deductibles and patient copay responsibilities to facilitate upfront collection.
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Coordination of Benefits (COB)
Auditing and updating who is primary, secondary, or tertiary to prevent payer-loop claim denials.
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Referral Management
Checking if the primary care physician (PCP) has submitted required referrals before scheduling.
Technology & Verification Systems
RTE Portals
Leveraging Real-Time Eligibility software loops to query payer databases instantly for fast verification.
EHR Scheduling Sync
Syncing eligibility status notes directly back to Epic, Cerner, and Athenahealth scheduling calendars.