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Reliable Care RCM
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Insurance eligibility & benefits verification

Coverage, costs and auth rules confirmed before the patient arrives.

We check each scheduled patient’s coverage before the visit: active plan, network status, deductible met so far, copay and coinsurance, visit limits, referral and authorization rules, and other insurance. Your front desk gets a short note it can act on.

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What we check
Coverage, costs and auth rules
How
271, payer portal or a call
Medicare
HETS lookup by MBI
Price
Included in full service

Why coverage is checked before the visit

Eligibility problems start at the front desk and surface weeks later. The plan ended last month, the patient changed jobs, a Medicare Advantage plan replaced Original Medicare, or the visit needed a referral nobody asked for. The claim denies, and the copay that should have been collected at check-in becomes a statement.

We check each scheduled patient before the visit and write down what we found where your staff will see it. Problems get fixed while there is still time: new insurance details from the patient, an authorization requested, or a self-pay estimate sent.

It is the cheapest part of denial management: the denial that never happens.

A person reviewing a form on a clipboard at a desk

What we check before each visit

The same eight points on every check, written the same way, so anyone at your front desk can read it.

  • Active coverageThe plan is active on the date of service, under the right member ID and subscriber.
  • Plan typeHMO, PPO, EPO, POS, Medicare Advantage, Medicaid managed care or Original Medicare, because each pays by its own rules.
  • Network statusWhether your rendering provider is in network for this plan, not just for the payer.
  • DeductibleThe deductible for the year and how much the patient has met so far.
  • Copay and coinsuranceThe patient’s share for this type of visit or service.
  • Visit limitsYearly limits on therapy, chiropractic and similar visits, and how many are used.
  • Referral and prior authorizationWhether the plan needs a referral from the primary care provider or an approval before the service.
  • Other coverageA second plan or Medicare Secondary Payer record that changes who pays first.

How we verify coverage

  1. Get the schedule

    We work from your appointment schedule a set number of days ahead, plus same-day bookings.

  2. Check each patient

    The 271 first, then the payer portal or a call for anything it leaves open.

  3. Write the note

    Results go on the appointment in your system, in the same format every time.

  4. Fix what can be fixed

    Missing insurance details, referrals and authorizations are chased before the visit.

  5. Hand off the rest

    Inactive coverage and self-pay patients go to your front desk with a clear next step.

How we check: the 271, payer portals and calls

Most checks start electronically. HIPAA has a standard eligibility transaction, the X12 270 inquiry and 271 response, and federal operating rules require health plans to answer in real time, with deductibles, copays, coinsurance and coverage for specific service types, according to CMS.

A 271 answers the common questions, not all of them. Visit limits, referral rules and a specific provider’s network status are often clearer on the payer’s portal or in a call, so we go there next and note the call reference number.

Medicare: the MBI and HETS

Medicare checks run on the patient’s Medicare Beneficiary Identifier (MBI), the number on the Medicare card. CMS tells providers to ask patients for the card when they come for care; the MBI can also be looked up in the Medicare contractor’s secure portal with the patient’s name, date of birth and Social Security number.

The check goes through HETS, CMS’s real-time 270/271 system. Per the HETS companion guide, the response shows Part A and Part B entitlement, Medicare Advantage and Part D enrollment, Medicare Secondary Payer records, the Part B deductible remaining, next eligible dates for preventive services, and Qualified Medicare Beneficiary (QMB) status.

Two results change what you bill. A Medicare Advantage plan in the response means that plan’s billing rules and cost sharing apply, not Original Medicare’s. QMB status means you must not bill the patient for Medicare deductibles, coinsurance or copays, so the front desk should not collect them.

Medicaid: check every date of service

Medicaid coverage can change between visits. Missouri’s Medicaid agency, for example, tells providers that eligibility can change daily and must be checked on each date of service. Other states set their rules in the provider manual.

We check the state’s portal or the 271 for the date of service, confirm which managed care plan the patient is assigned to, and note it on the appointment so the claim goes to the right plan.

Good faith estimates for uninsured and self-pay patients

Under the No Surprises Act, patients with no coverage, or who choose not to use it, must be given a written good faith estimate when they schedule or ask for one. Under 45 CFR 149.610, it is due within 1 business day of scheduling when the service is at least 3 business days away, and within 3 business days when it is at least 10 business days away or the patient asks. The provider must also ask whether the patient has coverage and wants to use it.

If the bill comes in at least $400 above the estimate for any provider or facility, the patient can dispute it, as the CMS model notice explains. We flag uninsured and self-pay patients at scheduling so the estimate goes out on time, and can draft it from your self-pay prices for your staff to review.

When to verify: choices your practice makes

These are practice choices, not rules. Your state Medicaid manual or a payer contract may set its own, and we write the schedule into your workflow.

  • New patientsAt scheduling, from the card details the patient sends, and again before the visit.
  • Returning patientsBefore each visit, or at least once a month for patients seen often.
  • Recurring visitsTherapy and similar series: monthly, with visit counts and authorization dates checked each time.
  • High-cost servicesImaging, procedures and infusions: before the service is booked, with the authorization confirmed.
  • Medicaid patientsEach date of service, where the state asks for it.
  • A new plan yearIn January, or the plan’s renewal month, when deductibles and visit counts usually start over.

What your front desk gets back

A short note on each appointment in your practice management system, before the patient arrives.

  • Coverage active or not, with the payer and member ID to bill
  • Copay, coinsurance and deductible left
  • What to collect at check-in
  • Flags for referrals, authorizations, visit limits and network
  • Secondary coverage and the order to bill in
  • The date, method and reference number of each check

Eligibility verification questions

Something else? Call +1 786-788-7313. A biller answers.

All questions

Eligibility confirms the patient has active coverage with that plan on the date of service. Benefits verification goes further: what the plan pays for this type of visit, the deductible left, the copay or coinsurance, visit limits, and referral or authorization rules. A claim can deny on either, so we check both.

No. A response reflects what the plan shows on the day you ask, and CMS’s HETS companion guide says the 271 should not be read as a guarantee of payment. Claims can still deny for coding, medical necessity, a missing authorization or a coverage change after the check, which is why every check is dated.

Far enough ahead to fix what you find. A practical default is two or three business days before the visit, then a same-day check for new bookings and any patient whose coverage looked uncertain. For high-cost services, check before the service is booked. The timing is your choice, and we set it with you.

Yes. When a check shows the plan needs an approval, our prior authorization team submits the request with the clinical records, follows it up and logs the approval number and dates on the appointment, so the claim goes out with it.

Our patient billing and support team. When a patient owes more than was collected at check-in, they send a clear statement, answer the patient’s questions and set up payment plans under your policy. Accurate benefits at check-in mean fewer of those calls.

If we run your full revenue cycle, eligibility and benefits checks are included in our full-service rate of 3% to 6% of monthly collections, with no setup or onboarding fees. Eligibility work on its own has no published price: we quote it after a free review of your schedule, based on your visit volume, payers and timing.

Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.

From our guides

Specialties we work with

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Want coverage checked before patients arrive?

Tell us your visit volume and payers. We’ll scope the work and quote it, free.

Get a free quote+1 786-788-7313