Benefits of eligibility & demographics verification by IMBS
Prevent day-of surprises with a proactive workflow. We run your scheduler four business days in advance, verify coverage, coordination of benefits (COB), referrals, authorizations on file, visit counts, and copay-assistance status, estimate patient responsibility using CMS fee schedules, and notify your onsite team three days prior to address any issues early.
Prevent day-of reschedules
Early checks catch terminations, missing referrals, COB conflicts, and authorization gaps — we alert your team three days before the appointment.
Secondary & assistance coverage
Secondary benefits are verified, and copay-assistance status is confirmed before calculating patient responsibility—closing gaps that could disrupt reimbursement.
Patient responsibility clarity
Copays, coinsurance, and out-of-pocket (OOP) costs are calculated against benefits and CMS fee schedules, allowing staff to set clear expectations and reduce confusion at check-in.
Authorization alignment
Eligibility reports explicitly confirm that an authorization is on file with the same payer, including dose and approved-visit tracking, to prevent denials.
Our verification workflow lets you concentrate on care
Eligibility reports are sent one day prior and again on the day of service to capture late additions, keeping front-desk operations smooth and claims processing clean.
Industry Standard tools that drive performance
Tight, repeatable checks reduce rework across coding, submission, and posting. Here’s how our verification translates into measurable revenue impact.
Benefits & coverage check
Active coverage, covered services, financials, and visit counts are verified in advance and shared with onsite teams for timely action.
COB & secondary validation
We confirm primary coverage, capture secondary benefits, and align both to prevent rejections and balance errors.
Copay assistance confirmation
Assistance programs are verified for active status before calculating patient responsibility, minimizing out-of-pocket surprises.
Authorization linkage
We cross-check that the authorization on file matches the payer on eligibility, including dose and visit-count validation to prevent denials.
Patient-responsibility estimator
Estimates combine benefits and CMS fee schedules to provide a realistic patient responsibility figure at pre-registration.
Scheduled report cadence
Eligibility reports are delivered one day prior and on the day of service, ensuring late additions are captured and nothing slips through.
