BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM Medical coding
🟢 Eligibility Verification and Benefits Check
You Take Care of Your Patients. Let Us Handle the Eligibility Verification and Benefit Check Process
Inconsistencies in eligibility verification and benefits checks will lead to insurance denials, delayed reimbursements, and revenue loss to a practice
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Response Time
99.9%
Accuracy Rate
500,000+
Verifications Completed
Overview
Why ASP-RCM Solutions is Your Go-To for Eligibility Verification
We take a data-driven approach to eligibility verification that prioritizes efficiency, accuracy, and compliance. Here’s why healthcare providers and patients trust us
Actionable Insights
Our system provides granular details such as CPT code-specific benefits, authorization requirements, and cost-sharing details, enabling informed decisions.
Real-Time Automation
By automating manual verification processes, we minimize errors and reduce turnaround times, enabling instant confirmation of patient eligibility.
Advanced Error Detection
Proprietary algorithms flag discrepancies in payer responses, ensuring you never miss critical coverage details.
Direct Integration with Payers
Our platform connects directly to hundreds of payer databases via EDI (Electronic Data Interchange), ensuring real-time updates on coverage.
Regulatory Compliance
We adhere to HIPAA and other regulatory standards, ensuring secure handling of sensitive patient data while maintaining operational excellence
Operations
A Closer Look at Our Workflow-Driven Verification Process
Our eligibility verification and benefits check process are designed with healthcare providers and RCM professionals in mind. Here's how we achieve operational excellence
Patient Information Capture
Through seamless integration with your EMR/EHR systems, we automatically capture patient demographics and insurance details at the point of scheduling.
Payer System Connectivity
Our platform establishes direct connections with payer systems, ensuring real-time eligibility status for Medicare, Medicaid, and commercial insurers
Coverage and Benefits Extraction
Beyond basic eligibility, we pull data on co-pays, deductibles, out-of-pocket limits, and specific coverage for planned procedures or services.
Validation and Error Reporting
Advanced rule engines validate payer responses, highlighting missing or inaccurate data for proactive resolution
Integration with Pre-Authorization
If a procedure requires prior authorization, our system identifies this need, integrating with pre-authorization workflows to streamline approvals.
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have securely received your patient and encounter data, we code, review, and submit claims to payers. We manage appeals and denials, track payments, and provide regular updates. Our process is designed to be efficient and transparent.
Our certified coders and billing specialists review every claim carefully. We use quality‑control checks, regular coding audits, and payer‑specific validation to reduce coding errors and the risk of denials.
Our denial‑management team reviews each denied claim to identify root causes. We correct issues, resubmit claims promptly, and, when needed, pursue appeals with payers to maximize reimbursement.
We offer flexible pricing tailored to client needs — including fixed fees, per‑claim pricing, or percentage‑of‑collections models depending on volume and services required. Contact us for a custom quote.
Yes. We specialize in seamless transitions from in‑house systems or other vendors. To ensure secure data migration, our team works closely with you and provides training as needed.
Resources
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Ready To Get Started
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