Real-Time Patient Eligibility Verification
Instantly verify active coverage, deductibles, co-pays, and coinsurance across all major US insurance carriers — before rendering patient care.
This tool is under active development
We are integrating with the Stedi 270/271 clearinghouse network
Real-time eligibility verification will be available shortly. Once live, you will be able to verify coverage status, deductibles, and copays in under 15 seconds — directly against live payer databases via HIPAA-compliant ANSI X12 270/271 transactions.
Everything You Need at the Point of Care
Here is a preview of the full feature set launching with the live eligibility engine.
Real-Time 270/271 Response
ANSI X12 eligibility inquiry transmitted and response returned in 2–15 seconds across all major payers.
Deductible & Out-of-Pocket Status
Individual and family deductible balances with out-of-pocket maximum progress — before the patient arrives.
Copay & Coinsurance Schedule
Primary care, specialist, urgent care, and ER copays plus in-network and out-of-network coinsurance rates.
Coverage Effective Dates
Policy effective and termination dates, plan name, group number, and full subscriber details.
HIPAA-Compliant & Secure
Zero patient data stored. All information exists only in transient RAM during the request lifecycle.
Printable Benefit Summary
Export a clean benefit summary for patient records — deductibles, copays, and coverage dates in one view.
Real-Time Benefits Verification Before Every Visit
Live 270/271 engine — know coverage status, deductibles, and copays before the patient arrives.
Real-Time 270/271
ANSI X12 eligibility inquiry transmitted and response returned in 2–15 seconds across all major payers.
Deductible & OOP Max
Individual and family deductible status plus out-of-pocket maximum with visual progress bars.
Copay & Coinsurance
Primary care, specialist, urgent care, and ER copay amounts plus in/out-of-network coinsurance rates.
Coverage Effective Dates
Policy effective and termination dates, plan name, group number, and subscriber details.
Verify Patient Eligibility in 3 Steps
From patient details to complete coverage summary in under 15 seconds.
Enter Patient & Payer Details
Input the insurance Payer ID, member ID, date of birth, and patient name. Use our Payer ID Lookup tool to find the correct ID first.
System Sends ANSI X12 270
Our engine transmits a HIPAA-compliant 270 eligibility inquiry to the payer's real-time response endpoint via Stedi's clearinghouse network.
Review Complete 271 Response
See active/inactive status, deductible progress, copay schedule, coinsurance rates, and coverage dates. Print the benefit summary for patient records.
The Revenue Impact of Real-Time Eligibility Verification
The Cost of Skipping Pre-Service Eligibility Checks
Front-end patient registration failures represent the single largest source of preventable revenue leakage in US healthcare operations. The American Medical Association estimates that 20–30% of all claim denials originate from eligibility-related discrepancies identifiable before a single clinical service is rendered. A patient whose employer changed insurance carriers between open enrollment periods may arrive with a card that now routes to a terminated plan — and neither the patient nor the front desk staff knows it until the denial arrives 14–30 days later.
How the ANSI X12 270/271 Transaction Works
The digital architecture behind eligibility verification operates on two complementary HIPAA transactions. The 270 Eligibility Inquiry encodes the patient's demographic and insurance data into a structured EDI format with hierarchical loops: ISA/GS envelope headers, 2000A (information source), 2000B (receiver), 2000C (subscriber), and 2000D (dependent). The destination payer's adjudication engine processes this against its active member database and returns a 271 Eligibility Response — populating EB segments with benefit status, DTP segments with effective dates, and MSG segments with plan-specific coverage notes. Round-trip time for most major payers: 2–15 seconds.
Batch vs. Real-Time Verification: The Timing Gap That Costs Revenue
Batch eligibility processing — where files compile overnight and results return the next day — introduces a critical vulnerability: by the time a denied policy is identified, the patient has already received care and left the facility. Real-time point-of-service verification eliminates this gap entirely. When eligibility runs at check-in, staff can collect the correct copay, communicate unmet deductible obligations, or identify inactive coverage before clinical resources are consumed.
Best Practice
Run eligibility checks at three touchpoints: (1) at appointment scheduling, (2) 24–48 hours before the visit, and (3) at check-in. This three-layer approach catches last-minute coverage changes and gives staff time to contact the patient before arrival.
Frequently Asked Questions
The ANSI X12 270 is a HIPAA-mandated electronic format for sending patient eligibility inquiries to payers. The carrier reviews its active member database and returns an ANSI X12 271 response detailing policy status, effective dates, copays, deductible balances, and coinsurance rates — all in 2–15 seconds.
A valid Payer ID only confirms the digital routing address exists. If the patient's premium payments lapsed, their employer changed carriers, or the plan was terminated, the individual policy is inactive — triggering eligibility denials 14–30 days after service even though the claim transmitted successfully.
Running eligibility checks at the point of service lets staff know immediately if a policy is active, what the deductible balance is, and what copay to collect. This prevents rendering services against inactive coverage and eliminates the most common source of back-end denials in the revenue cycle.
You need the insurance Payer ID (use our Payer ID Lookup tool), the patient's member/subscriber ID from their insurance card, the patient's date of birth, and their first and last name. All five fields are required to generate a valid 270 inquiry.
We are currently completing our integration with the Stedi clearinghouse network for live 270/271 transactions. Enter your email in the notification form above and we will let you know the moment it goes live.
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