FASTER VERIFICATION. FASTER PAYMENTS.

Eligibility & Benefits Verification Services That Prevent Denials

Verify Coverage Upfront. Reduce Denials. Get Paid Faster.

Unverified coverage is responsible for nearly 23% of first-submission denials. Most of those are preventable. When you outsource eligibility verification to Dastify Solutions, every patient’s insurance is confirmed, active, accurate and complete before care is delivered across multiple states, including state-specific Medicaid programs, regional HMOs and 800+ national commercial payers, scalable from solo practitioners to large health systems.

Real-time eligibility verification integrated with EHR and payer portals
Prior authorization confirmation for services requiring pre-approval
Transparent insurance data delivered to your staff at the point of care
Detailed benefit breakdown including copays, deductibles, co-insurance and coverage limits

— No Obligation

How Our Eligibility Verification Process Works

Instant Coverage Confirmation

Connect directly with your EHR, practice management system or payer portals to confirm active coverage in real time.

Detailed Benefit Analysis

Check deductibles, copays, co-insurance and coverage limits by CPT and ICD code so your team has complete benefit detail before the patient arrives.

Batch and Bulk Processing

Upload entire patient lists or ANSI 270/271 files and we verify coverage for every scheduled patient within 24 hours.

Prior Authorization Support

Confirm authorization requirements per CPT code and initiate the PA workflow automatically when verification identifies a service requiring pre-approval.

Automation and Expert Oversight

RPA validates eligibility in seconds while our billing specialists resolve exceptions, payer portal failures and hard-to-verify cases with same-day turnaround.

— Payer Integration

Payer Connections and Integration Depth

We maintain direct API connections with Medicare (CMS HETS), Medicaid state MMIS portals and major commercial payers including UnitedHealthcare, Aetna, Cigna, Anthem Blue Cross Blue Shield, Humana and 800+ regional plans through Availity and Change Healthcare clearinghouse networks.

Verification response details:

Active or inactive coverage status
Group vs. individual coverage type
Benefit year start date
Deductible amount and amount met to date
Out-of-pocket maximum and amount met
Copay and co-insurance by service category
In-network vs. out-of-network benefit differentiation
Prior authorization requirements by CPT code range

For payers without real-time API connectivity, our specialists conduct direct payer portal verification or outbound calls with same-day turnaround so no patient hits your schedule unverified.

— Government Payers

Medicare and Medicaid Eligibility Verification

Medicare Advantage Verification

Medicare Advantage patients have plan-specific benefits, authorization requirements and cost-sharing that differ entirely from traditional Medicare. Billing traditional Medicare rates for an MA patient generates systematic claim errors. We verify MA plan assignment and plan-specific benefits separately from Part A and Part B coverage so your billing team knows exactly which rules apply before the claim is built.

Medicaid Monthly Verification

Medicaid eligibility changes monthly for populations with variable income or employment status. We verify Medicaid eligibility at scheduling and again on the date of service, not just at scheduling, to capture mid-month coverage changes that affect billing. Real-time state MMIS portal checks confirm current enrollment status before every encounter.

— Coordination of Benefits

Coordination of Benefits Verification

Patients with dual coverage require confirmed payer order before billing. Billing the wrong primary payer generates a CO-22 denial every time. We verify COB status through ANSI 270/271 transactions for every patient with multiple insurance records, confirming payer order and secondary benefits before the claim is built.

— Unified Workflow

Eligibility Verification and Prior Authorization as One Workflow

For services requiring prior authorization, eligibility verification is the trigger point, not a separate process. When our verification identifies that a specific CPT code requires authorization for a patient’s plan, we automatically initiate the authorization request workflow without waiting for a separate clinical team referral.

This eliminates the 1 to 3 day gap between eligibility verification and PA request that allows procedures to be scheduled without authorization in place. Authorization confirmation numbers are documented in the patient record and linked to the billing workflow, preventing the missing authorization denials that occur when authorization numbers are not captured before claim submission.

The recent CMS-0057-F rule requires Medicare Advantage and Medicaid managed care plans to issue expedited authorization decisions within 72 hours and standard decisions within 7 calendar days. Our PA workflow is built around these timelines, flagging pending authorizations that are approaching the statutory decision window and escalating non-responsive payers automatically.

— Specialties

Eligibility Verification Specialty-Specific

Every specialty has distinct coverage requirements, authorization rules and benefit structures. Here is how we handle verification for the specialties where errors cost the most:

Cardiology

Device implant pre-certification and stress test professional vs. technical component coverage confirmed before procedure date

Behavioral Health

Behavoiral health parity benefits, session limits and PA requirements verified per payer and diagnostic code

Orthopedics

Surgical pre-certification, global period implications and workers comp authorization routing confirmed upfront

Physical Therapy

Visit limits, Medicare therapy cap exceptions and PT authorization requirements verified before the first session

Oncology

Chemotherapy benefit coverage, specialty pharmacy vs. buy-and-bill determination and infusion authorization confirmed before treatment begins

DME

HCPCS code coverage, CMN requirements and competitive bidding area eligibility verified before equipment is ordered

Each specialty verification follows a workflow built for that specialty’s specific coverage and authorization patterns. Not a generic eligibility check that misses the detail that matters for your claims.

— What's Different

What Makes Our Eligibility Verification Services Different

Full Benefit Details in Every Transaction

Most vendors return active or inactive status. We return deductibles met, authorization requirements by CPT code and COB payer order in a single transaction. Your billing team knows what the insurance covers before the patient sits down.

Same-Day Manual Resolution

When portals time out or a patient's coverage requires phone verification, our specialists handle it the same day. No patient reaches their appointment with unresolved coverage.

PA Workflow Built In

Eligibility and prior authorization run as one connected process. When verification flags a service requiring PA, the request initiates automatically without your clinical team managing that handoff.

— Expertise

Expertise Across Multiple Medical Specialties

Every specialty has unique coverage requirements, coding rules, and payer guidelines. We adjust our verification process to the specific requirements of each specialty. This ensures coverage details are accurate. It also helps secure authorizations and reduce claim denials.

— Choose Your Plan

Transparent Pricing With No Hidden Fees

Starter

For Solo & Small Practices

Starting @ 3.99%

*Based on collections