Medical Coding
AAPC-certified coders using ICD-10 and CPT to maximize reimbursement on every claim submitted.
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Core Service
Insurance Eligibility Verification
Real-time eligibility checks that prevent claim rejections before they happen — at the point of scheduling.
HIPAA Compliant
97%+ Clean Claims
Dedicated Account Manager
Eligibility errors are the #1 cause of preventable claim rejections. Our real-time verification process confirms active coverage, benefits, deductibles, and authorizations before every appointment — eliminating surprises for both your practice and your patients.
By verifying eligibility at the time of scheduling and again 24 hours before the appointment, we catch coverage issues before the patient arrives. This protects your revenue, reduces claim rejections, and improves the patient financial experience.
Key Benefits
Real-Time Verification
Instant eligibility checks through direct payer connections and 270/271 EDI transactions — results in seconds, not hours.
Verification at Scheduling
Coverage confirmed when the appointment is booked and again 24 hours prior — two checkpoints that catch lapses in coverage.
Benefit Details
We verify deductible status, copay amounts, coinsurance, out-of-pocket maximums, and visit limits — so patients are informed before arrival.
Authorization Checking
Prior authorization requirements identified and flagged — preventing costly claim denials due to missing authorizations.
Rejection Prevention
Eligibility-related rejections represent up to 30% of initial claim failures. Our verification eliminates this entirely.
Better Patient Experience
Patients who know their costs before the visit have higher satisfaction and lower AR — clear upfront communication reduces billing disputes.
Our Eligibility Verification Process
We integrate directly with your scheduling workflow to provide eligibility checks at the right times — no manual requests needed from your front desk staff.
- 270/271 EDI real-time eligibility transactions
- Verification at time of scheduling
- 24-hour pre-appointment re-verification
- Deductible, copay, and out-of-pocket verification
- Prior authorization requirement identification
- Coverage lapse notification and patient communication support
Related Services
Denial Management
Proactive denial prevention and rapid appeals that recover revenue most practices don't know they're missing.
Learn MoreCredentialing
Full payer enrollment and re-credentialing to get your providers billing faster without revenue gaps.
Learn MoreStart Recovering Revenue Today
Our free billing audit takes less than 48 hours and shows you exactly where money is slipping through the cracks.
No contracts • No setup fees • HIPAA-compliant at every step
Frequently Asked Questions
Everything you need to know about working with Prime Medical Billing for your insurance eligibility verification needs.
Most practices see measurable improvements within the first 30–60 days. Clean claim rates typically rise within the first billing cycle as we correct root-cause coding and documentation issues. Full revenue optimization — including recovered denials and reduced AR days — is usually evident within 90 days.
No. We integrate with all major EHR and practice management systems including Epic, eClinicalWorks, Athenahealth, Kareo, DrChrono, Practice Fusion, Greenway Health, and more. Our onboarding team handles the technical setup.
Before any data is shared, we execute a formal Business Associate Agreement (BAA) with your practice. All data transfers use encrypted channels, our staff are trained on HIPAA annually, and we conduct regular security risk assessments.
Our average first-pass clean claim rate is 97–98%. We measure this as the percentage of claims accepted by payers on first submission. Each client receives a monthly performance report tracking this and other key metrics.
No denied claim goes unaddressed. Our denial management team reviews every denial within 24 hours, determines the root cause, corrects the claim, and re-submits with supporting documentation before payer appeal deadlines.