Eligibility Verification
“Active” Is Not Enough. You Need the Details.
A basic eligibility check tells you a patient has coverage. It doesn't tell you whether that coverage applies to the service you're about to provide, what the patient owes, or whether an authorization is required. KeyMed Partners captures the details that actually determine payment — before the visit, not after the denial.
Shallow Checks Create Expensive Surprises
Your system says the patient is eligible. You provide the service. The claim is denied because the specific procedure wasn't covered, the benefit limit was exhausted, or the service required prior authorization. A basic active/inactive eligibility check would have missed all of that. Industry estimates put the cost of reworking a denied claim at $25 to $118. Meanwhile, over 50% of denied claims are never refiled at all — they become permanent losses. The information was available. Someone just needed to look for it.
Real-Time Eligibility Verification
We verify every patient's coverage in real time before the appointment, not in a batch the night before. Real-time checks catch same-day coverage changes that batch processes miss.
Full Benefit Breakdown
We go beyond active/inactive status to capture copay amounts, deductible status, coinsurance percentages, out-of-pocket maximums, and coverage limitations. Your billing team gets the full picture, not just a green checkmark.
Authorization Requirement Detection
If the scheduled service requires prior authorization under the patient's plan, we flag it immediately during verification. No claim gets filed for a service that needed an authorization and didn't have one.
Patient Responsibility Estimation
Based on verified benefit details, we provide estimated patient responsibility so your front desk can collect accurately and your patients aren't surprised by a bill six weeks later.
30-50%
Denial Reduction
Deep benefit verification prevents the claim denials that shallow eligibility checks miss.
99%
Verification Accuracy
Our team captures eligibility and benefit details at 99% accuracy. When we report a copay or deductible status, your billing team can rely on it.
84%
Aged AR Collection Rate
Built in part on the front-end accuracy that thorough benefit verification provides. Clean data in, clean claims out.