Eligibility/Benefits Verification and Prior Authorization Services
The Impact of Ineffective Verification & Authorization
Poorly executed eligibility and benefits verification or prior authorization processes can significantly disrupt your revenue cycle and patient experience. Common issues include:
- An increase in claim denials
- Delayed payments and reimbursements
- The burden of rework and administrative backlogs
- Treatment delays and rescheduled appointments
- Patient dissatisfaction due to billing surprises
- Lost revenue for services already rendered
At MedRev, we eliminate these issues through proven processes and specialized support.
How MedRev Helps
Our expert team is dedicated to streamlining your revenue cycle by accurately verifying insurance eligibility and securing prior authorizations—before the patient visit. We work closely with hospitals, clinics, and physician offices to ensure accurate, real-time updates to your revenue cycle systems.
Our Step-by-Step Process
Step 1: Receive Patient Schedule
We receive the upcoming appointment list directly from your provider’s office or EHR system.
Step 2: Enter Patient Demographics
We input patient data into our verification system for both primary and secondary payers.
Step 3: Verify Coverage & Benefits
We check insurance eligibility, ensuring active coverage on the date of service, including:
- Copays
- Deductibles
- Coinsurance
- Out-of-network limitations
Step 4: Initiate Prior Authorization
Where required, we initiate and manage prior authorization requests with payers—ensuring timely approvals for treatments.
Step 5: Update Your Systems
We document and update your practice management or hospital revenue cycle system with all verified coverage and authorization details.
Key Benefits of Our Services
Faster Care Delivery
Efficient verification and authorization enable timely patient scheduling—enhancing satisfaction and optimizing physician time.
Fewer Claim Denials
By confirming insurance coverage and securing prior authorizations upfront, we reduce denial rates and accelerate reimbursement cycles.
Reduced Bad Debt & Higher POS Collections
When patients know their financial responsibility upfront, it leads to improved collections, fewer billing surprises, and better patient trust.
Industry-Leading Expertise
We work with all major commercial and government payers—including BCBS, Aetna, Humana, UnitedHealthcare, Medicare, and Medicaid.
- Multi-specialty support across diverse states
- Scalable services for practices of any size
- Knowledge of payer-specific requirements and timelines
Why Choose MedRev?
With MedRev as your partner, you gain a proactive team that ensures your practice stays ahead—not behind. From eligibility checks to pre-authorizations, we handle it all with accuracy, speed, and payer-specific expertise.