Most denials are expensive because they are discovered late: weeks after the visit, after the claim was built, submitted and rejected. Eligibility problems are different. They can be found, and fixed, before the patient ever walks in.

50%of providers cite missing or inaccurate data as a top denial cause
32%cite incomplete or inaccurate patient registration data
35%cite authorization problems

Source: Experian Health, State of Claims 2025.

Why it is the cheapest denial to prevent

A pre-visit check takes minutes and, with automation, often no staff time at all. A denial found after submission means rework, resubmission, a longer wait for cash, and sometimes revenue that is never recovered. Experian Health also found that 55% of providers say each eligibility re-check takes at least 10 minutes, time that multiplies quickly when checks are done by hand and after the fact.

What a complete check covers

  • Active coverage on the date of service, not just "on file."
  • Plan, product and network: HMO, PPO or Medicare Advantage, and whether your provider is in network.
  • PCP assignment for HMO and managed care members, essential for MSOs and IPAs.
  • Patient responsibility: copay, deductible remaining and coinsurance.
  • Coordination of benefits: secondary coverage and which plan is primary.
  • Referral and authorization requirements for the planned service.
  • Carve-outs such as behavioral health, lab or imaging managed by another vendor.

When to check

  1. At scheduling, to catch inactive coverage and authorization needs early.
  2. One to three days before the visit, with automated batch 270/271 checks for every appointment.
  3. At check-in, to confirm nothing changed and collect the patient's share.
  4. For recurring visits, re-verify each month or plan period, especially for Medicaid members.
The winning model: automate the routine checks and let trained staff work only the exceptions: inactive coverage, mismatched IDs, COB conflicts and missing authorizations.

Measure it

  • Eligibility- and registration-related denial rate
  • Percentage of visits verified before the date of service
  • Point-of-service collection rate
  • Time from scheduling to authorization approval

How Rimage helps

Rimagination runs real-time 270/271 eligibility and benefits checks before every visit and flags exceptions automatically. Our BPO team handles pre-visit verification, coverage and copay checks, and prior authorizations, with turnaround and accuracy reported every month.

Stop eligibility denials at the front desk

Our BPO team and Rimagination's automated 270/271 checks verify every visit in advance and flag the exceptions.

Request a Demo Explore BPO Services

Sources

  1. Experian Health: 3rd Annual State of Claims Survey (Business Wire, September 22, 2025)
  2. Experian Health: Common causes of eligibility-related claim denials

This article is for general information and is not legal, coding, billing or compliance advice.