Insurance eligibility and benefits verification before every visit
Most denials start at the front desk. ClaimEdgeSolutions verifies active coverage, plan details, copays, deductibles, coinsurance and referral requirements before each appointment, so claims go out right and patients know what they owe.
Common problems we fix
If any of these are happening in your practice, revenue is slipping away every week.
- Denials for inactive coverage or the wrong payer
- Surprise patient balances that hurt satisfaction and collections
- Front-desk staff on hold with payers all morning
- Missed referral or authorization requirements
How ClaimEdgeSolutions handles eligibility & benefits verification
Pre-visit verification
Coverage checked 48–72 hours before scheduled appointments.
Full benefit breakdown
Copay, deductible met/remaining, coinsurance, visit limits and out-of-network rules.
Coordination of benefits
Primary and secondary payers identified correctly.
Referral & auth flags
Services that need referrals or prior authorization are flagged early.
Patient estimates
Clear cost estimates the front desk can share at check-in.
Same-day add-ons
Urgent and walk-in verifications handled quickly.
Specialists who own your eligibility & benefits verification
You get named people who learn your providers, payers and workflows, not a rotating queue. Every open item has an owner and a deadline.
- Pre-visit verification
- Full benefit breakdown
- Coordination of benefits
The metrics we report on
Your monthly report tracks these numbers for this service, alongside your overall revenue cycle KPIs.
Share of scheduled patients
Claims denied for coverage
Copays collected at check-in
From audit to results in four steps
Free revenue audit
We review your A/R aging, denial history, payer mix and coding patterns, then show you what is recoverable.
Onboarding
BAA signed, secure system access set up, workflows mapped and your dedicated team assigned.
Daily operations
Claims, payments, denials, A/R and patient billing are worked every business day.
Monthly review
A KPI report and a call with your account manager covering results and next steps.
Often paired with Eligibility & Benefits Verification
Medical Billing & Coding
Certified coders and billers who turn every encounter into a clean, compliant claim.
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Revenue Cycle Management
End-to-end RCM from patient scheduling to the final zero balance.
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Credentialing & Enrollment
Get providers enrolled with payers faster, and keep them active.
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Frequently asked questions
Straight answers about how ClaimEdgeSolutions works with your practice.
Ask us anything01How far in advance do you verify?
Typically 48–72 hours before the visit, with same-day checks for add-ons and urgent visits.
02Where do results go?
Directly into your practice management system or schedule notes, whichever your team uses.
03Do you verify Medicare Advantage and Medicaid plans?
Yes, including managed Medicaid and Medicare Advantage plans.
04Can you produce patient cost estimates?
Yes. Estimates help with point-of-service collection and No Surprises Act good-faith estimates.
05Do you sign a Business Associate Agreement?
Yes. A BAA is signed with every client before we access any protected health information.
See where your revenue is leaking
Get a free, no-obligation revenue audit. We review your A/R, denials and coding patterns and show you exactly what is recoverable.