Eligibility checks: a five-minute checklist before every visit

Eligibility verification answers three questions before care is delivered: is the patient covered on the date of service, which services need approval, and what will the patient owe at the visit. Doing this in advance turns a surprise into a conversation the patient can prepare for.

The checklist

• Confirm active coverage for the date of service, not just today
• Check whether the planned services need prior authorization or referral
• Note the patient responsibility for deductibles, copays, and coinsurance
• Record the verification date, the staff member, and any reference number
• Flag secondary coverage and coordination of benefits questions early

Timing matters

Verify coverage a few days before the appointment, then check again on the day if the appointment is more than a week away. Coverage changes at renewal, and employer plans often change in January. Build the verification into scheduling so it happens automatically rather than relying on memory.

Keep a short script for patients. A sentence like "Your plan requires approval for this test, and we have started that request for you" is clearer and more reassuring than a bill after the fact.