How far in advance do you verify eligibility?

Typically 48 to 72 hours before the appointment, with a same-day recheck for high-dollar or high-risk visits. This gives your front desk time to contact patients about coverage issues before they arrive.

Do you handle secondary and tertiary coverage?

Yes. We identify coordination-of-benefits situations and verify secondary and tertiary payers so claims are sequenced correctly and nothing is written off as patient responsibility that a second payer should cover.

Can you estimate what the patient will owe?

Yes. Using the verified benefit detail, we can produce an estimated patient responsibility so your front desk can collect at the point of service instead of billing after the fact.

What happens when a payer only shows eligibility on its portal?

Automation covers standard 270/271 transactions; for portal-only plans our specialists check the payer portal directly. We treat those exceptions as part of the service, not an add-on.

All services

Eligibility & Benefits Verification

The problem

Most denials aren't coding problems — they're eligibility problems that were never caught. A patient's plan terminated, the copay was wrong, the service needed prior authorization, or coverage simply didn't include the procedure. By the time the claim is denied, the visit is over, the patient is gone, and your team is chasing money that could have been secured in thirty seconds at the front desk.

How NuGenera Health does it

We verify eligibility and benefits before every scheduled encounter, not after. For each appointment we confirm active coverage, plan type, effective and termination dates, in- versus out-of-network status, copay, coinsurance, deductible remaining, out-of-pocket maximum, and any service-specific limitations or authorization requirements.

Verification runs on a rolling schedule tied to your appointment calendar — typically 48 to 72 hours ahead, with a same-day recheck for high-dollar or high-risk visits. Discrepancies (terminated coverage, unexpected out-of-network status, missing authorization) are flagged to your front desk with a clear, plain-language note and a recommended next step, so patients can be contacted before they arrive rather than surprised at check-out.

Because eligibility is the single largest source of preventable denials, we treat it as a first-class KPI. Verification completeness and downstream eligibility-related denial rate both appear on your monthly scorecard, so you can see the direct line between clean front-end work and protected revenue.

Key capabilities

Real-time and batch eligibility checks across commercial, Medicare, Medicaid, and managed-care plans
Benefit detail capture: copay, coinsurance, deductible, OOP max, and service limits
Prior-authorization requirement flags routed to your auth workflow
Coordination-of-benefits and secondary-payer identification
Front-desk-ready exception reports with recommended actions
Estimated patient responsibility to support point-of-service collections

Technology that supports it

We connect through your clearinghouse (Waystar, Availity, or Office Ally) and work directly inside your EHR/PM system to run automated 270/271 eligibility transactions at scale. Automation handles the high-volume, routine checks; our specialists manually resolve the ambiguous responses — the vague benefit descriptions and payer-portal-only plans that automation alone gets wrong.

Frequently asked questions

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