Eligibility & Prior Authorization
Eligibility verification confirms a patient’s active coverage and benefits, and prior authorization secures payer approval before certain services. Novusmedix handles both at the front end, where preventing a denial is far cheaper than appealing one later.
What we do
- Real-time and batch eligibility verification
- Benefit and coverage detail confirmation
- Prior authorization initiation and tracking
- Documentation gathering for authorization requests
- Authorization status follow-up to resolution
- Front-end denial prevention reporting
What is eligibility and prior authorization?
Eligibility verification checks that a patient’s insurance is active and confirms the specifics of their benefits before service. Prior authorization is advance approval a payer requires for certain procedures or services.
Both happen at the front of the revenue cycle. Getting them right is the single most effective way to prevent downstream denials.
Why it matters
Eligibility and authorization problems are among the most common — and most preventable — reasons claims are denied. Catching them before service protects both revenue and the patient experience.
It also reduces surprise balances for patients, since coverage is confirmed up front.
How Novusmedix handles it
We verify coverage and benefits ahead of the visit, initiate and track required authorizations, and follow each request to resolution — flagging anything that needs a provider decision.
The result is fewer front-end denials and a cleaner claim from the start.
FAQs
Eligibility & Prior Authorization questions
Related services
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