Maximize Revenue
with AI-powered
Eligibility Verification

Streamline your eligibility verification processes and patient access functions with SolvEdge’s AI-driven solutions. Eliminate errors, reduce denials, and enhance your front-end revenue cycle for a seamless care experience.

  • ✓ Reduce Denials
  • ✓ Increase Efficiency
  • ✓ Transform Patient Access
Healthcare admin reviewing eligibility data on AI-powered dashboard
Healthcare admin reviewing eligibility data on AI-powered dashboard

The Challenges of Manual Verification

  • Errors and Delays: Manual processes often lead to inaccuracies and time-consuming workflows.
  • Revenue Leakage: Missed eligibility checks result in increased claim denials.
  • Administrative Burden: Staff spends hours on repetitive tasks instead of focusing on patient care.

Why Choose SolvEdge

Healthcare admin reviewing eligibility data on AI-powered dashboard
Team Discussion

Eligibility and Enrollment Services

Expand access to care by serving uninsured patients with Medicaid eligibility, financial counseling, and enrollment services.

Team Discussion

Proprietary AI Solutions

Identify insurance coverage issues and continuously improve workflows with AI-driven processes.

Team Discussion

Cost Containment

Leverage our global delivery model to reduce front-end revenue cycle costs and time.

Team Discussion

98% First Pass Claim Acceptance Rate

Achieve compliance with insurer-specific policies and maintain a high clean claim rate.

Simplify Patient Registration & Insurance Verification: Optimize Billing with AI-assisted Healthcare Solutions

1

Patient Registration

Collect patient demographic and insurance details, like name, date of birth, and policy number, during scheduling or registration. Ensure accuracy to facilitate eligibility verification and billing. This step supports seamless care coordination.

2

Insurance Payer Verification

Submit patient insurance details to payers like Medicare or private insurers via electronic systems or phone. Verify coverage status to proceed with services. This reduces claim denials due to invalid insurance.

3

Eligibility Confirmation

Review payer's response for active coverage, benefits, co-pays, and deductibles. Ensure alignment with the patient's plan and provider needs. This promotes financial transparency.

4

Data Documentation

Record verified eligibility details in the patient's EHR or billing system. Maintain clear records for compliance and reference. This supports efficient billing processes.

5

Follow-Up

Resolve discrepancies in insurance data by contacting the payer or patient. Ensure all information is accurate before proceeding. This prevents delays in care or billing.

6

Pre-Authorization (if required)

Obtain insurer pre-approval for specific procedures using payer protocols. Submit clinical documentation for medical necessity. This prevents claim rejections.

7

Billing Preparation

Prepare accurate claims using verified eligibility data, including co-pays and covered services. Align with payer guidelines for timely reimbursement. This minimizes denials.

Proven Benefits for Your Practice

Avoid Unexpected Costs

Proactively minimize claim denials by confirming coverage details in advance. Enable smoother cash flow and improved patient financial transparency.

Real-Time Checks

Perform real-time eligibility checks against multiple insurance carriers to save time and enhance productivity. Focus on patient care, not paperwork.

Transition from Manual Processes

Unlike error-prone manual workflows, automation ensures instant verification, reducing administrative burdens and boosting cash flow.

What Sets SolvEdge
Apart?

Healthcare admin reviewing eligibility data on AI-powered dashboard
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Client Testimonials

“SolvEdge’s AI-assisted eligibility services have transformed our workflow. We’ve reduced denials by 40% and improved cash flow significantly.”

CEO
Leading Healthcare Practice

Ready to Transform Your Revenue Cycle?

Let SolvEdge help you reduce costs, eliminate denials, and focus on delivering quality care.

FAQ – SolvEdge Patient Eligibility Verification

  1. Conduct patient eligibility verification using eligibility verification software and AI eligibility verification tools to ensure accurate insurance data.
  2. Support revenue cycle management by performing automated eligibility checks that help reduce claim denials.
  3. Manage patient access solutions to verify insurance benefits and improve healthcare revenue optimization.
  4. Collaborate with billing teams to streamline medical billing eligibility and ensure compliance (HIPAA).
  5. Utilize healthcare technology and EHR/EMR integration to reduce administrative burden and enhance operational efficiency.

  1. Use eligibility verification software like Availity for real-time insurance eligibility checks for medical practices.
  2. Perform automated eligibility checks to quickly confirm patient coverage and benefits.
  3. Integrate Availity with your EHR/EMR system for seamless patient eligibility verification.
  4. Leverage Availity's tools to support front-end revenue cycle processes and improve cash flow improvement.
  5. Utilize these features as part of a HIPAA compliant eligibility verification service to protect patient information.

  1. Employ AI eligibility verification and eligibility verification software for accurate patient eligibility verification.
  2. Use payer portals and automated eligibility checks to validate insurance details.
  3. Combine real-time insurance eligibility checks for medical practices with EHR integration for better data accuracy.
  4. Leverage healthcare practice management systems to support medical billing eligibility and reduce errors.
  5. Use these methods to aid healthcare revenue optimization and improve the patient experience.

  1. Patient eligibility verification ensures accurate billing and supports efficient medical claims processing.
  2. Utilizing AI eligibility verification and eligibility verification software reduces errors and administrative burden.
  3. Timely verification improves front-end revenue cycle performance and decreases claim denials.
  4. It enhances financial counseling efforts by providing accurate patient benefit information.
  5. Eligibility verification is a critical component of healthcare revenue optimization and cash flow improvement.

  1. Insurance verification should occur at every patient encounter to maintain real-time insurance eligibility checks for medical practices.
  2. Frequent automated eligibility checks ensure up-to-date information and reduce claim denials.
  3. Verification before scheduled services supports front-end revenue cycle management.
  4. Regular checks contribute to healthcare practice management and improve patient financial transparency.
  5. Implementing AI solutions for patient eligibility can automate this process and improve productivity enhancement.

  1. Verify insurance before patient appointments to optimize patient access solutions and reduce claim denials.
  2. Conduct patient eligibility verification prior to procedures as part of front-end revenue cycle efforts.
  3. Re-verify upon insurance plan changes or annually during medical billing eligibility reviews.
  4. Integrate verification into EHR/EMR systems for continuous updates and better healthcare administration.
  5. Timely verification is essential for HIPAA compliant eligibility verification services ensuring compliance.

  1. Early verification reduces administrative burden by preventing claim denials and billing errors.
  2. It ensures patient financial transparency and enhances the patient experience.
  3. Supports healthcare revenue optimization by improving cash flow improvement and reducing delays.
  4. Enables efficient medical claims processing by verifying medical billing eligibility.
  5. Using AI eligibility verification tools provides fast and accurate results while ensuring HIPAA compliance.

  1. Collect patient data and use eligibility verification software to perform automated eligibility checks.
  2. Confirm coverage details with real-time insurance eligibility checks for medical practices.
  3. Integrate results into healthcare practice management and EHR/EMR systems.
  4. Identify any patient financial responsibilities to improve patient financial transparency.
  5. Leverage AI solutions for patient eligibility to reduce manual errors and speed up revenue cycle management.

  1. Verify insurance plan details and patient coverage status through eligibility verification software.
  2. Confirm provider status in healthcare practice management systems to support medical billing eligibility.
  3. Validate that the process complies with HIPAA compliant eligibility verification services.
  4. Cross-check insurance carrier information to prevent claim denials.
  5. Use AI eligibility verification tools for faster and more accurate results.

  1. Use patient eligibility verification via eligibility verification software integrated with EHR systems.
  2. Perform automated eligibility checks to confirm insurance coverage and benefits.
  3. Analyze the data to support front-end revenue cycle operations and medical billing eligibility.
  4. Provide results to billing and administrative teams to enhance healthcare revenue optimization.
  5. Employ AI eligibility verification to improve accuracy, reduce administrative burden, and enhance patient access solutions.