Eligibility and benefits verification

Eligibility Hub runs real-time 270/271 eligibility checks against payers through its clearinghouse connection. Each response comes back in one format: coverage status, plan, deductible and out-of-pocket, copay and coinsurance, and whether authorization is required. Checks run from the chart in one click or through the API, and every check is kept in history.

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At a glance

Availability: AvailableMedicare checks need your Medicare EDI enrollment and HETS attestation. Dental frequencies and history need a dental clearinghouse connection that is in progress.
Part of the cycle: Verify: eligibility, benefits and verification requests
What it costs: Included in the full service at 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included.
Your practice: Capture insurance cards and member IDs at intake

Who does what

Eligibility Hub does

Run checks from the chart in one click, or through the API
Return coverage, plan, deductible, out-of-pocket, copay, coinsurance and authorization flags in one format
Explain why a check could not run, such as a missing member ID or an unsupported payer
Keep a full history of every check

Your practice does

Capture insurance cards and member IDs at intake
Complete Medicare EDI enrollment and HETS attestation before Medicare checks run

Limits worth knowing

An eligibility response confirms coverage on the date checked. It is not a promise of payment.
Dental frequency and history detail waits on the dental clearinghouse connection, which is in progress.
Whether a specific product is covered is a separate question, answered by the coverage check.

Questions

What does an eligibility check return?

Coverage status, plan, deductible and out-of-pocket, copay and coinsurance, and whether the service needs authorization, in one format for every payer.

Does it work for Medicare?

Yes, once your practice has Medicare EDI enrollment and HETS attestation in place. We confirm both with you during setup.

Does it work for dental plans?

Coverage checks run today. Dental frequencies and history need a dental clearinghouse connection that is still in progress.

Is a verified response a promise the claim will be paid?

No. It confirms coverage on the date checked. Payers decide payment after the claim is submitted.

Review the scope before you begin

The full service is 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included. See pricing for how the fee is calculated.