Check eligibility before the session
Insurance coverage can lapse or change without anyone telling you. A quick check before each session catches problems while they're still easy to sort out.
- A client policy on file: member ID, plus names and dates of birth for the client and policyholder
- An electronic payer connected, with your practice credentialed and enrolled (lesson 4.5)
Run the check
- Go to Clients → select the client → Insurance tab.
- Check the policy has the member ID, plus names and dates of birth for the client and the policyholder.
- Hover over the policy → Eligibility request → pick a benefit code → Check eligibility.
You can also run it from the appointment itself: open it and click View → Check Eligibility. And if the client filled in your intake form, the check already ran when their policy was created, so often all you need to do is read the result.
Read the result
Once the report is back, the policy shows a Verified tag. You're confirming two things:
- The coverage is active
- The details match the card: member ID, group, plan, dates
Click View report if you want the detail: co-pay, coinsurance, deductible. If the check fails, it's usually fixable: fill in both profiles (names and dates of birth at minimum), make sure your billing profile matches what the payer has enrolled, and try again with a single benefit code.
Prior authorization and referrals
Some payers need authorization before certain services, and they'll only accept it from you, the treating practice. It's worth getting before the session, because once a session happens without a required prior auth, there's no way to recover that revenue.
Save the authorization or referral on the client's chart under Documentation, so it's there when the claim is built.
Tick these off in your own workspace before moving on.
Three ways practices time the check.
There's no single right rhythm. Pick whichever fits how your week runs.
Monday morning, one pass through the week's booked clients. Anything that fails gets a phone call before the visit.
A quick check a few minutes before each video call, with the calendar as the prompt.
The intake form collects the policy and the check runs itself. Staff just read the result.
What does a check cost?
15c per request, pay as you go. A request that fails because the details were wrong still counts, so it's worth getting the policy right first.
What do I need before I can run one?
A paid plan, an electronic payer (manually added payers aren't supported), your practice credentialed and enrolled with that payer, and a client policy on file.
Does Verified mean the claim will be paid?
No. It confirms the coverage is active and the details are right. The claim still needs the right codes and a signed note behind it, plus prior auth where the payer asks for it.
How long does it take?
Usually it's instant, though some payers take a few minutes. Refresh the page, then click View report for the detail.