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Cut Claims Denials for Your Customers With Advanced Eligibility Verification Software
Basic eligibility checks aren’t enough anymore. Tightening payer rules and front-end breakdowns are driving claims rejections and revenue losses. Vendors who deliver smarter, more complete workflows alongside trusted eligibility verification software can help customers minimize denials, reduce administrative burden, and get paid faster.
The Shifting Coverage Verification Landscape
Providers are under pressure as payers tighten requirements and costs rise,
meaning the smallest mistakes can now trigger denials that are harder than ever to recover.
In 2023, Healthcare.gov rejected 20% of claims.2 The cost of contesting those denials jumped by 23% between 2022 to 2023.3
Front-End RCM Breakdowns Create
Costly Denials Downstream
The biggest cause of denials are front-end workflows – specifically eligibility verification – and the early missteps have big financial implications. Half of hospitals and health systems recover less than 50% of denied claims,1 and roughly 25% of denied claim charges cannot be recovered at all.4
Providers Need More Complete Front-End Workflows and Smarter Eligibility Verification Software
Providers expect more than the basic checks that standard eligibility verification software offers.
They want complete, real-time coverage data delivered in a single workflow that limits manual effort.
Add capabilities, add value
Real-time eligibility, MBI validation, demographic confirmation, and insurance discovery via APIs give providers the complete picture they expect.
Less system-hopping
A single clearinghouse connection avoids the need to manage multiple payer portals.
Automate workflows to reduce manual work
Automation limits rekeying and manual chasing down insurance info, freeing staff to focus on patients.
Help customers handle more volume
As providers expand networks and volumes, vendors who enable higher transaction capacity and complex checks can stand out in a crowded market.
Practical Steps to Evolve Eligibility Verification
Stand out by helping providers move beyond the norm with eligibility verification software
that proactively tackles common issues and exceptions.
Differentiate with scalable workflows
Use integrated APIs to build flexible verification that grows with provider needs and reduces administrative burden.
Boost efficiency with streamlined eligibility checks
Enable near real-time verification and reassign exceptions automatically to keep work moving.
Minimize rejections with complete patient data
Pinpoint missing and inaccurate patient data with access to the industry’s largest healthcare dataset.
Maximize revenue with full coverage
Identify secondary and undisclosed coverage early to increase reimbursement opportunities, prevent write-offs, and avoid bothering patients with surprise bills.
Go Beyond Basic Eligibility Checks
Incomplete or outdated results frustrate providers and patients alike and it’s often the software that gets blame. Vendors who can provide comprehensive eligibility verification software and smoother workflows can help customers cut denials, protect revenue, and strengthen loyalty.
Help customers capture every dollar.
Improve eligibility verification to minimize rejections, improve first-pass yield, and stand out in a competitive market.
- “Why Your Claims Are Getting Denied—and What to Do About It,” Oncology Practice Management (oncpracticemanagement.com), July 2023
- “Claims Denials and Appeals in ACA Marketplace Plans in 2023,” KFF, January 27, 2025, https://www.kff.org/private-insurance/issue-brief/claims-denialsand-appeals-in-aca-marketplace-plans-in-2023/
- “Providers ‘potentially wasted’ almost $18B in 2023 overturning claims denials, Premier estimates,” Dave Muoio, Fierce Healthcare, February 26, 2025, https://www.fiercehealthcare.com/providers/providers-potentially-wasted-almost-18b-2023-overturning-claims-denials-premier-estimates
- “Claims Denials: Causes, Impact, and AI-Enabled Prevention Strategies,” Inovalon, October 2024, https://www.inovalon.com/resource/claims-denialscauses-impact-and-ai-enabled-prevention-strategies/
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