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Eligibility Verification

We conduct real-time insurance eligibility verification and obtain necessary prior authorizations to streamline patient access to care and minimize claim denials. Our process ensures accurate understanding of patient benefits, including co-pays, deductibles, and other out-of-pocket costs, enabling better upfront communication and financial transparency.
• Conduct real-time eligibility checks through payer portals and clearinghouses to confirm coverage details
• Verify active insurance status, plan type, and specific benefit coverage, including exclusions and limitations
• Assist in obtaining prior authorizations for procedures, diagnostic tests, and surgical interventions, ensuring timely approvals and compliance with payer requirements

Planning and sketching

Modern and unique design practically point of view, it risks not meeting the huge expectations

Team working

Modern and unique design practically point of view, it risks not meeting the huge expectations

Flowchart and wireframe

Modern and unique design practically point of view, it risks not meeting the huge expectations

User experience Testing

Modern and unique design practically point of view, it risks not meeting the huge expectations

ACA Commercial Risk Adjustment Coding

We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.