Eligibility Verification

and Pre-Certification Services

Avoid delayed reimbursement

and other negative outcomes to insurance eligibility denials

Eligibility verification is the first and most critical step to complete in order to receive accurate and timely information about a patient’s insurance coverage and reimbursement.

Yet eligibility verification is one of the most neglected key elements in the revenue cycle process due to the staff’s overwhelming schedules and administrative tasks. 


Neglecting eligibility verification creates reimbursement challenges and results in other negative outcomes for your practice. On average, 40% of healthcare denials are due to lack of insurance verification or improper insurance verification. This is a common costly negligence that impacts timely reimbursement and your bottom line.

Plus,  lack of insurance verification results in:

  • Cash reduction due to claim denials for terminated coverage
  • Delayed insurance payments
  • Decreased patient satisfaction due to hassles of denied claims and incorrect patient statements

Benefits of an Efficient Eligibility Verification Process

When you address the challenges  of verification and precertification, it helps to eliminate the negative outcomes above by

  • Enables office to input correct insurance information 
  • Facilitating a smoother workflow with the patient and minimizes customer service issues
  • Increasing accurate copay or time of service collections

Legacy Billing Solutions Insurance Verification and Precertification Services

Legacy Billing Solutions’ experienced team of Eligibility Verification Specialists can verify benefits electronically or via the automated system to obtain verification and precertification in advance of patients’ visits.  We take the following steps for your group:

  • Obtain your schedule or list of new patients in advance of the patients’ scheduled appointments and verify coverage on all primary and secondary payers. We use websites, Automated Voice Response and phone calls to the payers, as necessary.
  • Perform verification of primary and secondary coverages, including the determination of
  • The verification service includes:
    • Member and Group IDs
    • Effective and term dates of coverage
    • Co-pays
    • Co-insurance
    • Deductibles
    • Type of plan and coverage details
    • Payable benefits
    • Patient policy status
    • Type of plan and coverage details
    • Plan exclusions
    • Referrals and pre-authorizations
    • Benefit maximums
  • Provide timely results within 24 hours to reduce administrative costs to you and provide your staff with the knowledge that they need to properly file a clean claim to the payer. This also ensures you collect co-pays and patient out of pocket expenses up front at the time of service.
  • Obtain preauthorization numbers and/or precertification numbers as required from the patient’s plan, ensuring timely payment of services rendered.

Why Centralize your Eligibility Verification with Legacy Billing Solutions?

We have a track record of realizing results and a significant ROI for our clients. The benefits of hiring our team for your verification and precertification needs include:

  • The revenue cycle starts with insurance verification, and we take the hassle and uncertainty off your plate
  • Cost-effective rates
  • Fewer denials and claims delays

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Many practices can get by with electronic batch billing through their EHR. This is a simple service that 2-3 days prior to the patient’s appointment, eligibility is checked to verify that the patient has active coverage. This system delivers a report of those who kick back without current coverage, so your registration team may reach […]

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Depending on your practice, eligibility can mean many different things to many different specialties. However, the key to a strong revenue cycle and patient collections strategy begins with eligibility verification. Basic Eligibility What is basic eligibility? This is checking with the insurance company ahead of the patient’s appointment to make sure they still have an […]

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Contact Legacy Billing Solutions Today

Contact us at 334-954-1076 or admin@legacyconsultingservices.com to discuss further or schedule a consult.
We offer a comprehensive suite of insurance and practice management services that simplify your practice
while also increasing your bottom line.