Know Before You Treat. Avoid Claim Denials. Improve Patient Satisfaction.
Verifying a patient’s insurance eligibility and benefits is a critical first step in the revenue cycle—and often the most overlooked. Failure to confirm accurate coverage information can lead to denied claims, delayed payments, and frustrated patients.
At Pristinesolutions , we offer reliable, real-time Eligibility and Benefits Verification services to help healthcare providers avoid billing issues, streamline patient intake, and improve financial performance.
Why Eligibility Verification Matters
Every provider has experienced it: treating a patient only to discover later that their insurance was inactive or their service wasn’t covered. That one small oversight can delay payment by weeks—or worse, result in total claim denial.
Proper eligibility checks ensure:
- Insurance coverage is active and valid
- The service is covered under the patient’s plan
- Copays, deductibles, and co-insurance amounts are known upfront
- Referrals or pre-authorizations (if required) are flagged early
- Clean claims are submitted the first time—without guesswork
Our Verification Services Include:
Real-Time
Eligibility Checks
We verify coverage through payer portals, clearinghouses, or direct payer contact to ensure the patient’s policy is active on the date of service.
Detailed
Benefits Review
We retrieve specific benefit details such as copay amounts, deductible status, co-insurance, out-of-pocket maximums, and service coverage limits.
Prior
Authorization Alerts
We identify procedures or services that require pre-authorization or referrals, giving you time to secure approval before care is rendered.
Patient
Responsibility Estimates
By understanding the patient’s benefits, we help you calculate what the patient may owe upfront—reducing surprises and improving collections.
EHR/PM
System Integration
Our services can be integrated with your existing Electronic Health Record (EHR) or Practice Management (PM) system to streamline workflows.
Custom Verification for
Specialty Services
We provide in-depth benefits verification for services like behavioral health, physical therapy, diagnostics, and telehealth, which often have complex payer rules.
Who We Serve
Our services are tailored for:
- Medical and Dental Practices
- Behavioral Health Providers
- Therapy Clinics (PT/OT/ST)
- Imaging and Diagnostic Centers
- Ambulatory Surgery Centers
- Home Health and Telehealth Providers
- Billing and RCM Companies
- Multispecialty Medical Groups
Why Choose Pristonsolutions
Accuracy
First
Avoid costly claim denials with precise and thorough verification.
Quick
Turnaround
Get verifications done quickly—often within 24 hours.
Experienced
Staff
Our team is trained in payer guidelines, plan structures, and specialty-specific requirements.
Improved
Collections
Clear patient responsibility means fewer surprises and better point-of-service payments.
End-to-End
Support
Combine with our prior authorization, billing, or credentialing services for full-cycle revenue protection.
Trusted Partners
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