Eligibility checks are your cheapest denial prevention

Late is expensive

When coverage is checked after the visit, or not at all, problems show up as denials weeks later. By then the patient may have changed plans, the practice has moved on, and fixing it means phone calls.

What a good check looks like

A 270 request asks the payer whether a patient is covered; the 271 response answers. A good eligibility habit means:

1. Running the check before the appointment or before the claim is built.
2. Reading the response properly, not just looking for the word "active".
3. Saving the answer so the claim builder can use it.
4. Keeping a history you can point to if the payer later disagrees.

The reading problem

271 responses are long and inconsistent across payers. Experienced billers know where to look; newer ones often don't. That's a good place for AI help: an agent can summarize the response, point out a likely prior-authorization requirement, and suggest what to ask the patient. A person still decides what to do with it.

Keep the receipt

Coverage disputes are much easier when you can show exactly what the payer told you and when. Treat eligibility history as evidence, not just a convenience.

#eligibility#270/271#prevention