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.

At Quintessence, we understand the significance of accurate and efficient eligibility and benefit verification. Our end-to-end verification services are designed to address these issues and streamline the revenue cycle chain. By partnering with us, healthcare companies can benefit from a comprehensive solution that ensures coverage validity, verifies primary and secondary payer details, determines allowed benefits, and manages factors like co-insurance and deductibles.

Our eligibility portal and verification services offer a cost-effective, time-bound approach to discovering patient eligibility and benefits. With seamless integration into your practice management system, we perform eligibility checks even for urgent care visits, allowing for smoother claim processing.

By choosing Quintessence as your eligibility and benefit verification service partner, you can overcome the challenges associated with inefficient processes. Experience improved cash flow, reduced claim rejections, faster payments, and ultimately, enhanced patient satisfaction. Trust us to handle this critical aspect of revenue cycle management while you focus on delivering quality healthcare to your patients.

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.

Top 10 Reasons to Outsource Eligibility and Benefit Verification Services to Quintessence

1. Expertise and Specialization:

2. Increased Claim Approval Rates:

3. Faster Payments:

4. Cost Savings:

5. Scalability and Flexibility:

6. Advanced Technology and Integration:

7. Enhanced Data Security:

8. Improved Patient Satisfaction:

9. Focus on Core Competencies:

10. Industry Compliance:

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