Know What Insurance Covers
Before the Patient Arrives.
Check a patient's active coverage, copay, deductible, and in-network benefits in real time — at booking, intake, or kiosk check-in. Front desk walks into every appointment informed. Fewer denials. No surprise bills.
Eligibility Result
BCBS — James Whitfield · Jun 2, 2026
Coverage Active
In-Network — Chiropractic Covered
Copay
$30.00
Deductible Remaining
$180.00
OOP Met
$820 / $2,000
Visits Remaining
18 of 24
Response in 1.8s · Logged to patient record
Three Problems Eligibility Verification Solves
Most billing problems start before the patient is ever seen. Real-time eligibility catches them first.
Claim Denials
The most common denial reason is inactive or ineligible coverage at time of service. Verify before the visit and you catch the problem when there's still time to act.
Surprise Bills
Patients who don't expect a balance dispute it harder. When you know their copay and deductible before the visit, you can tell them what they owe before the appointment ends.
Front Desk Time
Calling payer phone lines for benefits takes 15–20 minutes per patient. Real-time eligibility returns the same information in seconds — freeing staff for patients, not hold music.
How It Works
Enter the patient and payer. Results in seconds.
Patient Enters Insurance
At booking, intake, or kiosk check-in, the patient provides their insurance ID and group number.
Eligibility Check Runs
MedSiteAI submits a standard 270 electronic eligibility inquiry to the payer in real time.
Results Returned
The payer's 271 response comes back in seconds — coverage status, copay, deductible, OOP, and benefit detail.
Staff See Flags
Coverage problems (inactive, out-of-network, no chiropractic benefit) surface clearly. Normal coverage shows clean.
What the Verification Returns
Every piece of data your front desk and billing team need
Real-Time Response
Eligibility results return in seconds using standard 270/271 electronic transactions — the same format all major payers support.
Copay and Deductible Detail
Know the patient's copay amount, deductible met vs. remaining, out-of-pocket maximum, and in-network vs. out-of-network status before they arrive.
Check at Any Stage
Run eligibility at booking, during intake, or at kiosk check-in. Verify once or re-check on the day of the visit — coverage changes, and fresh data matters.
Coverage Problem Flags
Inactive coverage, terminated plan, or out-of-network status surface clearly — not buried in raw payer data. Staff see what needs attention before the appointment.
Works with Major Payers
Connects to major commercial carriers, Medicare, Medicaid, and most regional payers. Coverage across the insurance plans your patients actually carry.
Saved to Patient Record
Each eligibility check is logged against the patient record with a timestamp and payer response. Useful for documentation and billing disputes.
Calling Payer Lines vs. Real-Time Eligibility
Manual Phone Verification
- 15–20 minutes per patient on hold
- Only available during payer business hours
- Verbal information — hard to document
- No way to re-check quickly on day of visit
- Errors from transcription or staff misunderstanding
MedSiteAI Real-Time Eligibility
- Results in seconds — no hold time
- Available 24/7, including after hours
- Structured digital response saved to record
- Re-check instantly on day of visit
- Consistent data directly from payer system
Why Practices Verify Before Every Visit
Fewer claim denials — coverage confirmed before services are rendered
No surprise bills — patients know their costs upfront
Front desk collects the right copay the first time
Staff time saved vs. calling payer phone lines
Catch inactive or changed coverage before the visit, not after
Eligibility history logged per patient for billing reference
Frequently Asked Questions
What insurance information does a verification return?
A standard eligibility check returns active/inactive status, plan name, coverage dates, copay amount, deductible (met and remaining), out-of-pocket maximum, in-network vs. out-of-network status, and covered services. The exact fields available depend on what the payer returns in their 271 response.
When should I run eligibility?
Best practice is to check at booking (to catch obvious issues early) and again on the day of the visit (because coverage can change between when a patient books and when they arrive). MedSiteAI supports both.
Which payers are supported?
Most major commercial carriers (UnitedHealthcare, Aetna, BCBS, Cigna, Humana), Medicare, Medicaid, and many regional payers. Coverage depends on the payer's 270/271 participation. A small number of payers don't support electronic eligibility and require a phone call.
Does eligibility verification guarantee a claim will pay?
No. Eligibility confirms that a patient's coverage is active and gives benefit details, but does not guarantee a specific claim will be approved. Claim-level authorization requirements and medical necessity reviews happen separately.
Is this the same as prior authorization?
No. Eligibility verification checks whether a patient has active coverage and what their benefits include. Prior authorization is a separate process where you get payer approval for a specific treatment before rendering it. Both matter, but they're different steps.
Stop Finding Out About Coverage Problems After the Visit
Real-time eligibility verification is built into MedSiteAI — check at booking, intake, or check-in.