Prioritize reimbursements with automated eligibility checks

Between patients taking on more payment responsibility and new regulations like the No Surprises Act, healthcare providers are at higher risk than ever of claim denials, rising AR days, payment delays, and non-compliance. Plus, the manual process of verifying accurate coverage is manually intensive, error-prone, inefficient, and time-consuming. Using an automated process to verify coverage at the time of service will help you improve staff productivity while experiencing fewer payment delays and claim denials.

Let us help you verify coverage prior to service, so you can focus on providing the best care for your patients.

Improve cash flow

Reduce claims denials and speed of payments with automated insurance eligibility and benefits data.

Avoid costly rework

Find correct coverage the first time.

Unlock Medicare reimbursement opportunities

Speed up Medicare reimbursements with our automated MBI Lookup Service that returns missing or invalid MBIs along with its Medicare benefit coverage.

Gain staff efficiency

Keep up with increasing patient demand by leveraging automated work queues created with preset or custom alerts.

Reduce bad debt

Lower your risk of bad debt by verifying insurance in real time.

Increase patient satisfaction

Empower your patients with accurate payment estimates and accelerated registration. 

Simplify your workflows

View eligibility responses in an easy-to-read format that notifies you when edits or follow-ups are required.

Find and rectify incorrect plan codes

Leverage eCare NEXT®'s Bad Plan Code (BPC) Detection to promptly alert and prevent costly denials for incorrect plan code usage on patient accounts.

Client Testimonial: Steinberg Diagnostic Medical Imaging

See how Steinberg Diagnostic Medical Imaging uses Experian Health’s eligibility products to validate patient coverage in under 30 seconds.


Live client sites


Seamless payer connections


Eligibility transactions in 2022

Deep dive into our eligibility process and workflow

How patient eligibility verification and MBI work together

  • Eligibility clearinghouse: Connect to 900+ payers, with backup connectivity to minimize payer-specific service interruptions.
  • Normalization: View patient information in eligibility responses across all payers.
  • Data enrichment: Unlock intelligence and detailed responses from payer websites and other accurate sources.
  • Search optimization: Find patient matches with certainty.
  • CAQH COB Smart® data: View primacy information for relevant transactions to increase accuracy and streamline your processes.
  • MBI Lookup Service: Improve Medicare reimbursement rates by automating MBI lookup and eliminating manual inquiries. 

Learn more about our Medicare Beneficiary Identifier (MBI) Lookup Tool

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Frequently Asked Questions (FAQs)

An eligibility check or health insurance lookup ensures patients have active medical insurance coverage. It verifies different aspects like insurance status, coverage details, and benefits for medical services, making sure billing is accurate and providers can be reimbursed, which ultimately supports patients in accessing the care they need without financial burden or surprises.

Methods include online portals, file batching, automated systems, and real-time direct communication with insurance providers. These streamline insurance verification software processes, making it easier for healthcare staff to confirm patients' coverage accurately. By releasing staff from time-consuming calls with insurance companies, patients receive the care they deserve without delays or confusion.

Verifying insurance eligibility ensures accurate billing, reduces claim denials, and enhances revenue cycle management. By streamlining the verification process, claims are paid faster with no rework. It also prevents surprises for patients regarding coverage and financial responsibility, fostering trust and transparency in the healthcare experience, ultimately supporting positive patient-provider relationships and making sure all individuals have access to quality care.

Incorrect verification leads to denied claims, causing delays and revenue loss for healthcare providers. Accurate verification reduces claim rejections, streamlining reimbursement processes, and improving financial outcomes for both providers and patients. By guaranteeing accurate eligibility verification, healthcare organizations can optimize revenue cycles, minimize administrative burdens, reduce denials with patient access solutions, and deliver seamless care experiences for all patients.

Insurance eligibility resources

father and son at hospital front desk

How to maximize eligibility verification

Read how unprecedented industry changes continue to threaten healthcare provider cash flow and why organizations must focus on eligibility in the patient access process.

man checking in at hospital desk

4 benefits of health insurance eligibility verification software

An automated solution that eliminates errors and reduces denials could pay big dividends across the revenue cycle. This article breaks down the key revenue-boosting benefits of health insurance eligibility verification software.

nurse and doctor talking

Avoid the common eligibility verification errors that impact revenue

Having the right health insurance eligibility verification software can make or break the healthcare revenue cycle. Here are 4 key issues to watch out for.

doctor and nurse looking at chart

How improved insurance eligibility verification drives claims engines

Verifying coverage earlier in the billing process with automated eligibility verification software increases the chance of submitting clean claims the first time.

Medicaid coverage at risk

Learn more about Medicaid Redetermination and how you can determine coverage to Prevent bad debt and serve your Medicaid population.

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*Access our Eligibility solution through the eCare NEXT®, OneSource®, BatchSource®, Premium EDI, or EDI interfaces.

Insurance eligibility verification made easy.

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