In the healthcare industry, claim denials are more than just a nuisance — they are a significant threat to your revenue cycle. Each denial means lost time, delayed payment, and increased administrative costs. Worse yet, some denied claims never get resubmitted at all, translating directly into lost revenue. Fortunately, one of the most effective strategies to minimize denials is often overlooked: real-time eligibility verification.

1. Reduce Claim Denials with Real-Time
Eligibility Verification
In the healthcare industry, claim denials are more than just a nuisance — they are a significant
threat to your revenue cycle. Each denial means lost time, delayed payment, and increased
administrative costs. Worse yet, some denied claims never get resubmitted at all, translating
directly into lost revenue. Fortunately, one of the most effective strategies to minimize denials is
often overlooked: real-time eligibility verification.
Real-time Eligibility & Benefit Verification Services provide immediate, accurate insurance
information at the point of care. This foundational step ensures claims are built on correct
coverage data from the start, drastically reducing the chances of rejection or underpayment.
When combined with timely Prior Authorizations Services, your practice can create a
seamless, denial-resistant billing workflow.
Let’s explore how real-time verification works, why it matters, and how it protects your revenue
from claim denials.

2. The High Cost of Claim Denials
Claim denials are more common — and more costly — than most providers realize. According
to industry studies, denial rates for medical claims range from 5% to 10%, with some healthcare
organizations experiencing rates as high as 20%. The administrative cost to rework each denied
claim can be over $25, and about 65% of denied claims are never corrected or resubmitted.
The top causes of denials include:
 Inactive or incorrect insurance coverage
 Services not covered by the plan
 Lack of prior authorization
 Missing or incorrect patient information
 Filing with the wrong payer
These errors are often avoidable — and most of them can be prevented before the claim is ever
submitted.
What Is Real-Time Eligibility Verification?
Real-time eligibility verification is the process of electronically confirming a patient’s insurance
status and benefit details before or during their visit. It provides immediate confirmation of:
 Active insurance coverage
 Plan type and payer information
 Covered services
 Copay, coinsurance, and deductible details
 Referral or authorization requirements
 Network status (in-network or out-of-network)
This process empowers your front-desk team to collect accurate information before rendering
services, avoiding missteps that can trigger claim denials.
Benefits of Real-Time Verification
1. Prevents Eligibility-Related Denials

3. One of the most frequent reasons for claim denials is billing an inactive policy or a payer the
patient is no longer enrolled with. Real-time verification immediately confirms coverage and
identifies the correct payer, reducing eligibility-related denials to near zero.
2. Enables Timely Authorizations
Certain procedures require payer approval before they’re rendered. Real-time verification flags
services that require prior authorization, allowing your team to initiate the request before the
appointment. Partnering with ensures these approvals are obtained correctly and efficiently — a
key factor in preventing costly denials.
3. Improves Patient Communication and Collections
Knowing coverage details ahead of time allows your team to provide accurate estimates of out-
of-pocket costs. This:
 Enhances transparency
 Boosts patient trust
 Enables point-of-service collections (copays, deductibles)
When patients understand their financial responsibility, they’re more likely to pay upfront and
less likely to dispute bills later.
4. Saves Time on Rework
Clean claims — those submitted accurately the first time — get paid faster and avoid the
administrative burden of appeals. Real-time verification gives your billing team the data they
need to:
 Submit claims with the correct payer ID
 Match services to covered benefits
 Avoid rejection due to mismatched dates or policy lapses
Why Manual Checks Are Not Enough
Many practices still rely on outdated, manual processes to verify coverage — such as calling
payers, logging into portals, or even waiting until the claim is denied. These methods are:
 Time-consuming: Staff spend hours on hold or entering repetitive data
 Error-prone: Manual entry increases the risk of typos and misinformation
 Inconsistent: Not every patient is checked, leaving room for missed verifications

4. Real-time Eligibility & Benefit Verification Services eliminate these issues by integrating with
your practice management system or EHR, providing automatic, accurate, and consistent
verification across all patients.
How It Works
A high-quality eligibility verification system works behind the scenes to connect with insurers
through clearinghouses and payer portals. When a patient schedules an appointment or checks in,
the system automatically:
1. Confirms policy status with the payer
2. Retrieves benefit details in real time
3. Flags any discrepancies or missing data
4. Alerts the team to authorization requirements
This streamlined workflow ensures your staff has the information they need — without
additional effort.
Integrated Prior Authorizations for Complete Protection
Verification alone is not enough to guarantee claim success. When services require payer
approval, failing to obtain authorization will still result in denials — even if coverage is active.
That’s why combining real-time verification with expert is essential. Once your system confirms
a service is covered but needs authorization, your PA team can:
 Initiate the request immediately
 Submit accurate, complete documentation
 Follow up and track the status
 Communicate the outcome before the appointment
This end-to-end approach ensures all payer rules are followed — and that your claims are
processed without delays or denials.
Key Metrics Improved by Real-Time Verification
Implementing real-time eligibility verification can transform your revenue cycle by improving:
 Claim acceptance rate: Fewer rejections from eligibility or coverage errors

5.  Days in A/R: Faster reimbursements due to fewer denials
 Patient collections: More payments made at the time of service
 Staff productivity: Less time spent on manual calls and corrections
Over time, these benefits lead to a stronger financial performance and a more satisfied patient
base.
Outsource for Maximum Efficiency
Building your own real-time verification process can be expensive and complex. That’s why
many practices outsource to trusted providers like Crese Medical Billing. Our Eligibility &
Benefit Verification Services are designed to provide accurate, fast, and seamless coverage
checks — tailored to your workflow.
Our experts integrate closely with your front-desk and billing teams to ensure:
 All patients are verified before visits
 All required payer data is collected
 Authorization needs are flagged immediately
 Coordination with ensures nothing falls through the cracks
This comprehensive approach dramatically reduces denials and maximizes your reimbursement.
Final Thoughts: Prevention Is More Profitable Than
Rework
Claim denials can drain your revenue cycle, increase operational costs, and damage patient
satisfaction. But they don’t have to. By implementing real-time Eligibility & Benefit
Verification Services and integrating with expert Prior Authorizations Services, your practice
can prevent denials before they happen — saving time, money, and frustration.
Whether you’re a small clinic or a multi-provider group, investing in the right verification
strategy is the smartest move you can make toward a healthier bottom line.