Insurance Verification & Prior Authorization
A denial that happens because coverage wasn't active, or a procedure needed authorization that was never requested, is one of the most avoidable kinds of lost revenue — the information needed to prevent it existed before the appointment even happened. Flint RCM verifies eligibility and manages prior authorization requests ahead of the visit, so coverage problems surface before a claim is filed instead of after it's denied.
Built for practices like yours.
- Practices with a high rate of denials tied to eligibility or missing authorization
- Specialties that routinely require prior authorization — imaging, procedures, certain medications
- Practices wanting to reduce same-day cancellations caused by coverage surprises
- Front-desk teams stretched thin manually checking payer portals for every appointment
What this fixes.
- Claims denied for eligibility issues discovered only after the visit
- Missing prior authorizations causing high-dollar procedure denials
- Patients surprised by out-of-pocket costs at or after the appointment
- Front-desk staff time consumed by manual, one-off payer portal checks
The work, in practice.
Eligibility and authorization are confirmed ahead of the visit and handed to your front desk before the patient arrives — not chased down after a denial shows what should have been caught earlier.
- Real-time eligibility and benefits verification ahead of scheduled visits
- Copay, deductible, and coinsurance identification before the appointment
- Prior authorization submission and tracking through approval
- Same-day turnaround support for urgent authorization requests
- Re-verification for recurring-visit specialties where coverage can change between visits
- Eligibility & benefits verification
- Copay/deductible/coinsurance breakdown
- Prior authorization submission & tracking
- Urgent/same-day authorization requests
- Re-verification for recurring visit schedules
- Pre-visit clearance handed to your front desk
Our process, start to finish.
Appointment Identified
Upcoming appointments are flagged for verification with enough lead time to resolve issues before the visit.
Eligibility & Benefits Checked
Coverage status, copay, deductible, and coinsurance are confirmed directly with the payer, not assumed from the last visit.
Authorization Requirements Identified
Procedures or services requiring prior authorization are flagged based on the payer's actual current rules.
Authorization Submitted & Tracked
Requests are submitted and tracked to approval, with urgent cases handled on an expedited basis.
Clearance Handed to Front Desk
Confirmed coverage and authorization status are handed off before the visit, so the front desk isn't finding out at check-in.
- Pre-visit clearance rate
- Authorization turnaround time
- Coverage-related denial rate over time
Common denials we watch for.
Without verification ahead of time, coverage and authorization problems don't disappear — they just show up later, as denials that could have been caught before the claim was ever filed.
- CO-27 — coverage terminated before the date of service
- CO-197 — precertification or authorization absent
- CO-A1 — claim denied, requiring review of payer remark codes for the specific reason
- Patient responsibility surprises when deductible or coinsurance wasn't confirmed before the visit
- Authorization on file for the wrong CPT code or date range
- Eligibility checked close enough to the appointment date to reflect current coverage, not a stale prior check
- Authorization requirements verified against the payer's current rules, which change more often than practices expect
- Urgent authorization requests worked on an expedited, same-day basis where payers allow it
- Authorization details matched against the exact CPT code and date range that will actually be billed
- Recurring-visit specialties re-verified between visits rather than checked once and assumed stable
Rules change by specialty — so does our approach.
VOB & Prior Auth looks different depending on what you bill. A few specialties where this shows up most:
Works inside the systems you already use.
Verification and authorization status are recorded directly in your existing EHR or practice management system — including AdvancedMD, Tebra, athenahealth, eClinicalWorks, DrChrono, NextGen, and Epic — so your front desk sees clearance status in the same place they already manage scheduling.
VOB & Prior Auth, answered.
Typically a few business days before the appointment, with enough lead time to resolve any coverage or authorization issue before the patient arrives.
Urgent requests are worked on an expedited basis rather than following the standard queue — payers vary in how fast they can turn these around, but we push for same-day resolution wherever possible.
Yes. Coverage and authorization can change between visits, so recurring-visit specialties are re-checked rather than verified once and assumed to stay the same.
We flag it to your front desk before the visit so the practice can decide how to proceed — reschedule, collect payment upfront, or expedite the authorization — instead of finding out after the claim is denied.
Explore the rest of the revenue cycle.
Catch coverage problems before the appointment, not after.
We'll show you how much of your current denial volume is tied to eligibility or missing authorization.