Insurance Eligibility & Verification

Synergy's eligibility and verification team checks coverage and benefits before the visit. If your practice also needs prior authorization or referral coordination, we offer that support under a separately priced service scope.

How we check coverage before the visit

• Validate appointment schedules from hospitals and clinics
• Verify primary and secondary coverage via payer portals, automated voice response and live calls to payers
• Contact patients directly for any missing information before the date of service
• Provide member ID, group ID, eligibility, coverage start/end dates and co-pay details to providers
• Flag any coverage issues in a patient's policy to your team proactively
• For authorization and referral coordination, explore our separately priced support service; it is not included in the discounted billing offer
• Update and correct demographic information for new and existing patients

Use the response without treating it as payment approval

An active eligibility response does not establish that every planned service is covered or that a claim will be paid. Benefits, applicable network rules, authorization requirements and the services actually provided still need review. Copay and deductible information helps your office discuss possible patient responsibility; it is not a final bill or a guaranteed amount.

For Medicare, the CMS HETS companion guide makes this payment limitation explicit. It also directs providers to confirm Medicare Advantage eligibility information with the plan. Use the relevant payer's information for the actual service date rather than assume one response covers every plan.

Agree how coverage questions reach your office

Define where the response and its check date are recorded, which benefits were confirmed and what remains unresolved. A coverage mismatch, missing information or unanswered payer question needs an owner and a next action. Agree when your staff receive those exceptions before the appointment, including how a changed service or appointment date triggers another review.

Eligibility verification and authorization approval are separate steps. Prior authorization and referral coordination require a separately priced scope. Clinical decisions remain with your practice; a benefits response does not make those decisions.