Eligibility & Benefits Verification

When a patient’s coverage has lapsed, a service isn’t included in their plan, or a referral is missing, the result is usually a claim denial — and often a delay in payment or lost revenue entirely. Unfortunately, these surprises often show up after care has been provided and the claim has been submitted. That’s too late.

At GladMedRCM, we believe those surprises should never happen. That’s why our Eligibility & Benefits Verification service is designed to catch problems before they impact your bottom line.

Prevent Denials with Proactive Verification

We verify every patient’s insurance information up front, well before the appointment or procedure. This includes:

• Confirming active policy status for the date of service
• Identifying deductible, co-pay, and co-insurance obligations
• Checking for any referral, prior authorization, or service-specific requirements
• Determining coverage restrictions or visit limits

This proactive approach can make a major difference — studies show that front-end verification alone can reduce denial rates by up to 40%. One health system, Providence Health, saved $18 million in potential denials in just five months by prioritizing this process.

Technology + Human Expertise = Reliable Results

We combine the speed of automation with the diligence of trained staff. Our system connects with hundreds of insurance payers for real-time electronic eligibility checks, while our team makes manual follow-up calls for plans without APIs or when something looks off.

We don’t just confirm coverage — we clarify what’s covered, under what conditions, and whether any financial or documentation steps are needed before treatment.

Empowering Your Staff and Patients

With clear benefit details in hand, your team can:

• Discuss financial responsibility with patients upfront
• Set up payment plans if needed
• Ensure referrals, authorizations, or paperwork are completed
• Verify provider or facility restrictions (e.g., in-network labs or imaging)

This kind of preparation avoids patient confusion, builds trust, and reduces the risk of unpaid bills from unexpected out-of-pocket costs.

Creating a Clean Path to Billing

Our eligibility verification report is fully documented, including:

• Verification details
• Reference numbers
• Payer representative names (for manual checks)

This creates a paper trail that protects your practice in the event of future payer disputes. We also flag secondary insurances and required authorizations, so when it’s time to bill, your claims go out clean and complete.

Boosting Revenue While Reducing Friction

The impact on your revenue cycle is significant:

• Fewer eligibility-related denials
• Faster reimbursements
• Fewer billing corrections or appeals
• Reduced patient frustration or bad debt

In short, we ensure you’re treating covered patients for covered services — with no surprises on the back end.

Let GladMedRCM Be Your First Line of Defense

Stop letting last-minute coverage issues delay or derail payment. With GladMedRCM managing your eligibility and benefits verification, you can focus on delivering care — while we make sure your patients are covered and your practice gets paid.

Ready to end avoidable denials for good? Connect with us today