Tomorrow's schedule verified tonight, with the exceptions on top
Eligibility and benefit verification is the largest administrative cost CAQH measures in medical care, and it lands on the front desk every day. The coverage check is quick. The benefit detail and the exceptions take the time. The agent runs the schedule overnight so your team starts the morning with the short list.
Examples use invented names and figures.
What the agent does
- Step 1Runs the schedule
Takes the next day's appointments and runs each patient through the 270/271 check and the payer portals your staff already use.
- Step 2Reads the benefits
Pulls what that visit needs: copay, deductible met, coinsurance, visit limits and any referral or authorization required. For dental, it pulls frequencies, waiting periods and history of service.
- Step 3Writes the results
Records the benefits in your practice management system, with the source and time of each check.
- Step 4Lists the exceptions
Inactive coverage, a second plan, a missing referral or authorization and any conflicting answers go to the top of the list for a person.
Calls to payers when the data conflicts and conversations with patients about what they will owe stay with your staff, and so does any decision to reschedule. Nothing about cost reaches a patient until a person has checked it.
- Verifications per day and minutes each
- Eligibility-related denials per month, such as CARC 27, 22 and 197
- Coverage surprises found on the day of the visit
- Patient estimates corrected after the visit
Questions about this agent
Does it work for dental offices?
Yes. Dental verification needs a full breakdown, so the agent fills your own breakdown form from the payer's portal and your practice management history. The sprint checks how your system, such as Dentrix or Open Dental, takes the results. Anything unclear goes to your insurance coordinator.
Do you need our payer portal passwords?
Not for the sprint, which works on sample documents with made-up patient details. For a build, your practice keeps every credential, the agent uses read-only access where the payer offers it, and it works within each payer's terms.