Catch coverage problems before the visit
Many preventable denials start at check-in. With eligibility verification ahead of scheduled visits, we confirm coverage, benefits, and authorization needs and let your front desk know what needs attention.
- Checked before visits
- Prior auth handled
- Front-desk alerts
The problems we hear about most
Before practices come to us for eligibility verification, these are the issues that keep coming up.
Coverage changes go unnoticed
Patients change plans, and nobody finds out until the claim comes back denied.
Missing prior authorizations
Services that need approval get performed without it, and payers refuse to pay.
Surprise patient balances
When benefits aren't checked, patients are surprised by their bills and collections get harder.
Everything included in our Eligibility & Prior Auth service
Certified billing and coding professionals handle every part of it, with HIPAA-compliant processes throughout.
Eligibility checks
Coverage confirmed for scheduled patients before they arrive.
Benefit details
Copays, deductibles, and coinsurance noted so your front desk can collect at check-in.
Prior authorization requests
Requests prepared and submitted with the clinical information payers ask for.
Authorization tracking
Pending authorizations tracked until approved, with alerts if a visit is at risk.
Front-desk alerts
Problems like ended plans or missing referrals flagged before the visit.
Coordination of benefits
Primary and secondary coverage confirmed so claims go to the right payer first.
How eligibility verification works with Optima
First, we set up a clear process from day one. That way, your claims keep moving while we get started.
Get the schedule
We receive your upcoming schedule through your EHR or PM system.
Verify coverage
Each patient's eligibility and benefits are checked ahead of the visit.
Handle authorizations
Services that need prior auth are submitted and tracked.
Flag issues
Your front desk gets a clear list of what needs attention before patients arrive.
Is eligibility verification right for your practice?
Tap anything that sounds like your practice today.
Let's see if we're a fit
Select the statements that describe your practice to see whether Eligibility & Prior Auth would help.
What eligibility verification changes for your practice
Fewer front-end denials
Coverage and authorization problems are caught before the claim is created.
Better check-in collections
Knowing benefits up front helps your team collect copays and deductibles at the visit.
Smoother check-ins
Your front desk hears about problems before the patient is at the counter.
Eligibility verification for 30+ specialties
Our team works by specialty, so they know the codes, modifiers, and payer rules that apply to yours.
Services that work well together
We verify ahead of each scheduled visit, so your team has time to act on any issues. The exact timing is set up around your schedule and workflow.
We handle prior authorization requests and tracking for the payers you work with, following each payer's process and requirements.
We flag it to your front desk before the visit so they can contact the patient, collect updated insurance, or discuss self-pay options.
Yes. Many practices keep check-in in-house and hand verification and authorizations to us.
See what eligibility verification could change. Start with a free audit.
First, we'll review a sample of your claims, denials, and A/R. Then we'll show you where your revenue cycle needs attention.