Eligibility verification
Coverage checked before the patient walks in.
Active coverage, copays, deductibles, and auth requirements, verified ahead of every visit.
Most eligibility denials start at the front desk.
Insurance eligibility verification confirms that a patient’s plan is active and covers the visit, and what the patient will owe, before the visit happens. It matters because bad intake data turns into denials: in Experian Health’s 2026 State of Claims survey (opens in a new tab), 43% of providers said 5% or more of their denials come from inaccurate data collected at registration and intake. The codes that follow, such as CO-27 and CO-31, are in our guide to common denial codes.
4 checks before every visit.
Heron checks electronically through your clearinghouse wherever it can, and through the payer portal when it must. It is faster and cheaper: the 2024 CAQH Index (opens in a new tab) puts a manual eligibility check at $8.57 and about 16 minutes for a provider, against $2.00 and 4 minutes for a fully electronic one.
Coverage is active
The plan is in force on the date of service.
Benefits are known
Copay, coinsurance, and deductible remaining, up front.
Auth needs are flagged
If the visit needs prior authorization, it is filed early.
The front desk gets the answer
Before the patient arrives, not after the denial.
Fewer surprises at check-in.
Active coverage confirmed
Plan, member ID, and dates checked.
Patient costs up front
Copay and deductible remaining, before the visit.
Auth requirements flagged
Filed with clinicals when the visit needs it.
Mismatched details caught
A wrong ID or birth date, fixed at intake.
Keep reading.
Prior authorization, explained
Why auth-related denials happen, and how to stop them before a claim reaches the payer.
Read DenialsCommon denial codes, explained
What the eligibility codes CO-22, CO-27, CO-31, and CO-109 mean, and how to fix each one.
Read DenialsHow to reduce claim denials
Measure your denial rate, fix the front end, and work the patterns that drive most of the loss.
ReadCommon questions, answered plainly.
What is insurance eligibility verification?
It is the check that a patient’s insurance is active and covers the planned visit, done before the visit. A full check also confirms benefits such as the copay and remaining deductible, and whether the service needs prior authorization.
When should eligibility be verified?
Before every visit, not only the first one. Coverage changes when patients switch jobs or plans, and many plans reset at the start of the year, so a check from last month can be wrong today.
Which denials come from eligibility problems?
Codes such as CO-27 (coverage ended before the service), CO-31 (the patient cannot be identified as the payer’s member), CO-22 (another payer may be primary), and CO-109 (the claim went to the wrong payer) usually trace back to eligibility or registration.
Does Heron check prior authorization requirements too?
Yes. When a visit needs prior authorization, Heron flags it during the eligibility check and files the authorization with the clinical documentation attached, then follows up with the payer until it clears.
Stop eligibility denials at the front desk.
A free audit of your last 90 days shows how many of your denials started with coverage or registration.