Eligibility and Benefits Verification Services

Healthcare providers have to verify the eligibility and benefits of every patient before the claim is filed. According to the Centers for Medicare and Medicaid Services (CMS), in 2019, the eligibility / benefits denial rates ranged between 1 and 50%. About 75% of these claims were rejected because the person was not eligible for the services rendered.

With inefficient Eligibility and benefit verification services, medical billing companies end up with the following problems.


Delayed payments leading to delayed access to patient care, resulting in low patient satisfaction


Increased claim rejections due to inaccurate or missing patient data


Decreased collections and increased bad debt


processing time

By having a effective eligibility and prior authorization service partner, healthcare companies can easily put together cleaner claims that can be checked and approved quickly without delays and hassles.

We offer end-to-end eligibility and benefit verification services that help clearly check the coverage validity, primary and secondary payer details, allowed benefits and other factors like co-insurance and deductibles. Our solutions also help handle prior authorization requests and other approvals that may be needed to hasten the revenue cycle chain. Our eligibility portal and the verification services helps eligibility and benefits discovery for patients in a cost-effective and time-bound manner. By integrating with your PMS, we perform eligibility checks even for urgent care visits.

Quintessence has also deployed BOTs to automate eligibility and prior authorization services. With QuintAna you can now verify eligibility and prior auth in seconds! You can learn more about QuintAna here!

Our end-to-end eligibility and benefits verification Services includes:

Checking the patient’s eligibility and obtaining prior authorization before the patient visit.

Follow-ups for approvals through the payer’s portal.

Verify patient demographic information.

Verify coverage of benefits with the patient’s primary and secondary payers.

Update your practice management system with the approvals and other information received from the payer.

Claim denial appeals where required.

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