Prior authorization and eligibility verification
Many denials begin before the claim is sent. We check coverage before the visit and request approvals before costly procedures, so claims are less likely to fail later.
Why these two steps matter
A claim for a patient whose coverage was inactive, or for a procedure that needed approval and did not get it, is likely to be denied. Fixing it after the fact takes far more time than checking first.
Eligibility verification
- We confirm that the patient’s coverage is active before the visit.
- We note the plan, the main benefits and any referral or authorization requirements.
- We flag problems early, so your front desk can contact the patient before the appointment.
Prior authorization
- We identify which services need approval under the patient’s plan.
- We prepare and submit the request with the documents the payer asks for.
- We follow up until the answer arrives and record the authorization number and its dates.
Payer rules change often, so we always work from the payer’s current requirements for each request.
Connected to denial prevention
The weekly report shows how many denials came from eligibility or authorization problems. That makes these steps measurable. When a problem repeats, you see it, and we help fix the process. Read about our denial management service.
Frequently asked questions
What is eligibility verification?
It is the check that confirms a patient’s insurance is active and shows what the plan covers, before the visit takes place.
What is prior authorization?
It is the approval some insurers require before certain services, procedures or medicines are provided. Without it, the claim can be denied.
Can you handle authorizations for any payer?
We work according to each payer’s requirements. During discovery, we confirm your payers and the services that usually need approval.
Do you guarantee an authorization will be approved?
No. The payer decides. We guarantee careful preparation, timely submission and follow-up.
Arovia RCM does not guarantee collection outcomes. Please do not send patient information through the website or by email before agreements are signed.
More ways we can help.
Tell us what you need. We will book the call.
Thirty to forty-five minutes. No preparation needed.