Take Control of Your Revenue — Verify Before You Bill
Verifying eligibility is the entry point and most important step in any revenue cycle because if you are still verifying eligibility through an old fashion manual process, or only verifying eligibility after claims denials, you are losing revenue and efficiency every day. Let Sirius Solutions Global make the eligibility verification process simple through a dependable team and process for accuracy. Book Your Free Consultation Today Quit verifying insurance eligibility the wrong way and leave it to Sirius Solutions Global.
What You Receive
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Complete verification report for every patient
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Real-time updates prior to patient visits
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Support with payer follow-up if eligibility issues result
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Optional direct entry to your PM/EHR system Summary dashboards and monthly reporting on performance
Results You Can Expect
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Up to 30% reduction in insurance claim denials
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Faster billing cycle — claims submitted with correct insurance data
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Less confusion for the patient and fewer billing inquiries
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More productive front desk and billing operations
Why Is Eligibility Verification So Important?
Not only are eligibility issues preventable, but these issues remain among the most common reasons for payments to be denied or delayed in the US healthcare system. When a claim is denied, many providers don't even know there was something with eligibility related. This puts a burden on them to follow up on payments and/or create direct bills to patients.
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When eligibility verification does not occur upfront, here's some of the outcomes:
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High denial rates by insurance companies
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Delayed claims and reimbursements
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Patients that get a bill unexpectedly and are frustrated or confused
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Increased rework for your own billing staff and means re-submission
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Business losses and negative revenue outcomes
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Put more simply, correct eligibility verification will drain fewer denials, turnaround payment faster, and have happy patients.
Why Choose Sirius Solutions Global?
Sirius Solutions Global allows you to enjoy the best of both worlds with automation and payer expertise, along with dedicated RCM experts to provide consistent service and accuracy at your verification. Here's how we're different:
✅ Automated + Manual Checks: We leverage EDI tools + manual verification when sourcing challenging payers.
✅ Trained Insurance Specialists: Our specialists are well informed and aware of payer rules, trends, and response formats.
✅ Coverage, Nationwide, All Payers: Medicare, Medicaid, Commercial Insurers, HMOs, PPOs
✅ HIPAA Compliant Process: All verifications handled with full data security
✅ Workflow Integration: We provide eligibility reports in your standard scheduling and billing workflows.
✅ Scalable for Small Practices or Large: We work within your process to schedule either 10 patients or 1,000 patients.
Patient Eligibility Verification Services
We don’t just find problems - we fix them and keep them fixed.
At Sirius Solutions Global, our eligibility verification service removes one of the biggest hidden drains on practice revenue: incomplete or incorrect payer and benefits information. We combine human verification, real-time payer lookups, and AI-assisted automation so claims start clean - and stay that way.
Quick snapshot - What we do, in plain terms
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Confirm the patient's insurance coverage and perks before their appointment.
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Among other coverage components are in-network status, deductibles, frequency limitations, financial incentives, and prior authorization requirements.
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Accurately forecast the financial circumstances of patients so that your front desk can properly provide the appropriate co-pay or arrange reasonable payment plans.
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Include with EHR/PMS so that confirmed benefits are apparent at check-in and in the clinical chart.
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Prioritize high-risk patients for manual review and use artificial intelligence to pre-screen for eligibility exceptions.
Deliverables you’ll receive
Deliverables you’ll receive:
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Verification logs with timestamps, staff initials, and evidence screenshots when required.
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Pre-visit patient financial estimates added to charts.
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Prior authorization status dashboard and pending-authorizations list.
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Weekly exception reports and monthly KPI dashboard.
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Monthly summary with topline impact (denials avoided, patient collections obtained at visit).
Measurable benefits (what practices commonly gain)
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Fewer eligibility-related denials and re-submissions.
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More accurate upfront collections and fewer patient surprise bills.
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Faster revenue cycles because claims are cleaned up before submission.
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Decreased time staff spend on retroactive verifications and appeals.
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Better patient experience because financial expectations are set clearly before care.
(We’ll quantify expected savings and impact for your practice during a free eligibility audit.)
Key performance indicators (KPIs) to track
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Percentage of patients verified pre-visit.
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Eligibility-related denial rate (before vs. after).
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Average time to complete verification.
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Prior authorization success rate and average turnaround time.
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Percentage of patient responsibility collected at visit.
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Days in AR for claims impacted by eligibility.
Common issues we fix (real-world examples)
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Wrong subscriber DOB causing carrier mismatch and denial.
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Expired policy on the day of service — caught before visit and patient rescheduled or deposit collected.
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Duplicate coverage not coordinated — claims sent to primary first and COB applied correctly.
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Missing prior authorization for complex imaging — request submitted, approval obtained and documented before service.
How our AI helps
We combine automation with humans in the loop so you get speed without risk.
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AI pre-fill & extraction: AI parses incoming insurance cards or uploaded documents (OCR) and pre-fills key fields for human validation.
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Pre-screening rules engine: Flags accounts where automated checks disagree or where prior auths are likely needed.
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Predictive prioritization: Your staff first considers the most important ones: predictive priority and rank verifications by risk (high-dollar treatments, multi-payer patients), among others.
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Auto-scheduling of rechecks: Artificial intelligence sends auto-scheduled verification notices for still pending coverage scheduled to expire.
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Data hygiene automation: Offers automated policy number patterns, flawed birth dates, and solutions for duplicate records data quality.
The final decisions and payer communications are made by trained staff — AI accelerates the work and reduces manual entry errors.
Our Eligibility Verification Services Include
We offer modular services - pick what you need or let us run the whole front-end workflow.
1. Pre-visit eligibility & benefits verification
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Real-time payer verification and benefits extraction (co-pay, deductible, remaining benefits, frequency limits).
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Determine whether services are covered and if prior authorization is required.
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Verify patient responsibility and suggested collection amount at check-in.
2. Prior authorization triage & initiation
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If payer requires prior auth, we prepare and submit the request (including necessary clinical documentation) and track status to completion.
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Escalation to clinical liaison for complex authorizations.
3. Real-time desk/phone verification
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Live verification by trained staff when patients call or schedule.
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Immediate updates to the patient’s chart and pre-visit checklist.
4. Batch verification & monthly sweep
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For high-volume practices, we run batch eligibility sweeps to catch upcoming lapses, coverage changes, or terminated policies.
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Automated alerts for members whose coverage ends before scheduled care.
5. Patient financial estimates & collections readiness
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Provide accurate patient estimates before care so front desk can collect co-pay or request deposits.
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Offer payment plan setup options before or after visit, depending on policy.
6. Insurance documentation & data hygiene
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Correct insurance identifiers, policy numbers, group numbers, DOB mismatches, subscriber relationships and coverage coordination.
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Duplicate coverage detection and coordination of benefits (COB).
7. EHR/PMS integration & automation
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Write verified benefit details back into your chart and scheduling screens.
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Trigger to-do items for prior auths and specialist notifications.
8. Reporting & audit trails
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Show verified results, verification timestamp, and staff member who completed verification for audit and compliance purposes.
How Our Process Works
Patient Schedule Received We either receive a daily patient list from you, or we can connect into your system and follow your patients that you have already scheduled into the future.
Insurance Information Collected Our staff collects policy numbers, payer ID, DOB, and coverage info from your patient or your staff.
Verification Efforts We determine eligibility using EDI tools, payer portals, or via telephone if needed we make sure the eligibility is complete.
Results Reported We report to you a complete verification report, including copay, limits on benefits, and if authorization is needed.
We will inform you of any discrepancies or expired coverage immediately so that you can reschedule or modify the record.
Who Needs Eligibility Verification Services?
Our products are excellent for:
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Internal medicine and primary care physician procedures
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OB/GYN, behavioral health, cardiology, dermatology, orthopedics, and other specialty clinics
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Dental offices need benefits verification prior to starting treatment.
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Rehabilitation, chiropractic, and physical therapy facilities
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Urgent care, ASCs, and hospitals
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Telehealth providers or out-of-state payer plans
