Pre-estimation & Eligibility Verification

Pricing Plans

Our Pricing Plans

Silver $10/hr
Obtain the appointment information from practice ▶
Gathering appointment details to verify patient eligibility and predetermine coverage, ensuring accurate pricing and smooth billing.
Checking Patient Insurance Eligibility ▶
Verifying active insurance coverage through payer portals or direct communication by calling the payer.
Provider Network Status Confirmation ▶
Confirming whether the provider is in-network or out-of-network to ensure correct billing and avoid unexpected patient costs.
HMO Plan & PCP Referral Verification ▶
Verifying HMO plan requirements and primary care physician (PCP) referrals to ensure services are authorized and covered.
Coverage Verification for Specific Services ▶
Confirming insurance coverage and benefits for specific medical services to prevent claim denials and unexpected patient costs.
Choose Silver
Gold $12/hr
Obtain the appointment information from practice ▶
Gathering appointment details to verify patient eligibility and predetermine coverage, ensuring accurate pricing and smooth billing.
Checking Patient Insurance Eligibility ▶
Verifying active insurance coverage through payer portals or direct communication by calling the payer.
Provider Network Status Confirmation ▶
Confirming whether the provider is in-network or out-of-network to ensure correct billing and avoid unexpected patient costs.
HMO Plan & PCP Referral Verification ▶
Verifying HMO plan requirements and primary care physician (PCP) referrals to ensure services are authorized and covered.
Coverage Verification for Specific Services ▶
Confirming insurance coverage and benefits for specific medical services to prevent claim denials and unexpected patient costs.
Patient Cost Determination ▶
Calculating patient responsibility such as deductible, co-pay, and coinsurance.
Choose Gold
POPULAR
Platinum $15/hr
Obtain the appointment information from practice ▶
Gathering appointment details to verify patient eligibility and predetermine coverage, ensuring accurate pricing and smooth billing.
Checking Patient Insurance Eligibility ▶
Verifying active insurance coverage through payer portals or direct communication by calling the payer.
Provider Network Status Confirmation ▶
Confirming whether the provider is in-network or out-of-network to ensure correct billing and avoid unexpected patient costs.
HMO Plan & PCP Referral Verification ▶
Verifying HMO plan requirements and primary care physician (PCP) referrals to ensure services are authorized and covered.
Coverage Verification for Specific Services ▶
Confirming insurance coverage and benefits for specific medical services to prevent claim denials and unexpected patient costs.
Patient Cost Determination ▶
Calculating patient responsibility such as deductible, co-pay, and coinsurance.
Report before 48 hours ▶
The report will be generated and sent 48 hours before the appointment date to ensure patients are contacted in advance and informed of their financial responsibility.
Same-Day Report Update ▶
Appointments booked within the last 48 hours will be reported on the day of the appointment.
Client Support ▶
Offering dedicated assistance to address client queries and ensure smooth operations.
Choose Platinum

Understanding Eligibility Verification and Pre-Estimation for Accurate Patient Cost Estimates

Eligibility verification and pre-estimation are two essential steps in medical billing workflows, but they serve different purposes in ensuring accurate patient cost estimates, clean claims, and stronger revenue cycle management.

1. Eligibility Verification – Confirms Insurance Coverage & Patient Benefits

Eligibility verification is the first step in reducing denials and preventing billing errors. It confirms the patient’s insurance coverage, benefits, and plan details before the appointment. This process checks:

  • Active insurance status
  • Deductibles, copays, and coinsurance
  • Out-of-pocket limits
  • Policy limitations and exclusions
  • In-network vs. out-of-network status
  • Prior authorization requirements

2. Pre-Estimation – Calculates the Patient’s Out-of-Pocket Cost

Pre-estimation uses data from eligibility verification to produce accurate patient cost estimates before services are provided. This step helps reduce payment delays and increases transparency for both patients and providers. Pre-estimation includes:

  • Estimating payer reimbursement
  • Calculating patient responsibility
  • Contracted payer rates
  • Procedure-level cost breakdown
  • Financial responsibility estimation

How Eligibility & Pre-Estimation Work Together

Both processes support accurate medical billing and help practices avoid denied claims, improve collections, and ensure patients understand their financial responsibility.

  • Eligibility verification confirms current coverage and benefits.
  • Pre-estimation converts those benefits into a clear cost estimate.

Together, they enhance revenue cycle efficiency, improve patient financial experience, and reduce claim denials.