Eligibility Verification & Authorization

Eligibility Verification & Authorization

A denial for "not covered" or "no authorization on file" almost never happens because the service wasn't medically necessary — it happens because nobody checked before the visit. ProEnrollment verifies active coverage, plan-specific benefits, copay and deductible status, and authorization requirements for every scheduled visit, then manages prior authorization submission and follow-up directly with the payer.

Coverage & Benefits Verification

Active coverage, plan type, copay, coinsurance, deductible status, and visit limits are confirmed before the appointment — not discovered at claim submission.

Prior Authorization Management

Authorization requests are submitted, tracked, and followed up with the payer so approvals are in hand before the date of service, including support for peer-to-peer review scheduling when a payer requests one.

Referrals & Pre-Certification

Referral requirements and pre-certification rules vary by plan. We confirm and document them before the visit and file documentation for audit-readiness.

Part of Complete RCM Medical Billing

Eligibility verification and authorization can be engaged on its own or as part of ProEnrollment's complete RCM medical billing services, alongside medical billing & coding, accounts receivable management, and CPT certified coding. Schedule a free consultation.

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