Eligibility Verification

Real-time eligibility checks confirm active coverage, co-pays, deductibles and prior-auth needs - so you bill the right payer, the first time.

MedXFlow runs automated 270/271 eligibility checks against payers the moment an appointment is booked, and re-checks on the day of service. Staff see active coverage, plan details, co-pay, deductible-remaining and whether a prior authorisation is required - surfaced directly in the worklist, with exceptions flagged for a human to resolve.

What's inside Eligibility Verification

  • Real-time payer checks - Automated 270/271 transactions confirm active coverage and benefits in seconds, not phone calls.
  • Co-pay & deductible surfaced - Patient responsibility is known before the visit, so front desk can collect at the point of care.
  • Prior-auth detection - Services that need authorisation are flagged early, with a task raised so nothing is delivered un-authorised.
  • Batch & day-of re-checks - Coverage is re-verified before service to catch plan changes and lapses since booking.

How it works

  1. Appointment triggers a check - Eligibility runs automatically as soon as the visit is booked.
  2. Benefits parsed and displayed - Coverage, co-pay, deductible and auth requirements appear in the worklist.
  3. Exceptions escalated - Inactive coverage or missing auth is flagged for staff to fix before the visit.

What you get

  • Bill the correct, active payer every time
  • Collect patient responsibility up front
  • Catch prior-auth requirements before service
  • Eliminate rework from coverage-related denials

Frequently asked questions

What is eligibility verification in medical billing?

Eligibility verification confirms a patient's active insurance coverage and benefits before care, so you bill the right payer and know the patient's copay, deductible and any prior-auth requirement up front.

How do you check patient insurance eligibility?

Run an electronic 270/271 transaction against the payer, or check the payer portal. MedXFlow automates 270/271 checks the moment an appointment is booked and re-checks before the visit.

How often should you verify insurance eligibility?

For every visit, and again 24 to 48 hours before the appointment, because coverage changes at month boundaries. Verifying once at scheduling is not enough.

What is a 270/271 transaction?

The 270 is the EDI eligibility inquiry sent to a payer; the 271 is the response with coverage and benefits. It is how real-time eligibility verification works electronically.