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Powered by StealthAgentsPre-visit eligibility review
Check active coverage, plan type, effective dates, and the benefits the visit requires. Record what was checked and the source of the information.
Practice workflow
Insurance Verification and Prior Authorization
Coverage checked before the visit, with the authorization trail in one place.
The assistant verifies eligibility, documents benefits, prepares prior authorization requests, and follows up on pending decisions so the practice knows where each patient stands before the appointment.
Who this is for
Built for the practice where you are still the backup.
This role fits a small practice that needs reliable administrative follow-through without adding another management layer.
- A practice with a high volume of new patients or referrals
- A specialty office where authorization delays block the schedule
- A front desk that verifies coverage only when the patient arrives
The schedule is confirmed before coverage is
A patient can have an appointment, a ride, and a completed intake form while the eligibility check is still unresolved. The practice discovers the problem at check-in.
Authorizations live in three places
A portal, an inbox, and a sticky note may each hold part of the story. Without a single record, the practice cannot tell whether a request was submitted, pended, or denied.
The patient learns about cost at the desk
A coverage or benefit surprise at check-in turns an administrative task into a difficult conversation. Earlier verification gives the practice time to prepare the patient.
Scope of work
What the assistant actually handles.
Each item below is documented before the role starts. The practice approves the boundaries, the systems, and the review points.
Authorization preparation
Assemble the clinical and administrative information the payer requires, submit through the approved channel, and record the reference number and expected decision date.
Pending and denied authorization follow-up
Check the status on a schedule, document the payer response, and prepare the next step for practice review when a request is pended or denied.
Patient cost preparation
Prepare the practice-approved estimate and coverage summary so the front desk can have a consistent conversation with the patient.
EMR documentation
Record authorization numbers, effective dates, and coverage notes in the practice's chart and scheduling system, using the fields the practice already uses.
Exception list
Maintain a short list of visits at risk because coverage, authorization, or documentation is unresolved, with the next action and owner.
What we need from you
Inputs before the first handoff.
- Next-day and next-week schedules
- Payer list and portal access approved by the practice
- The practice's verification checklist and benefit fields
- Authorization requirements by service or payer
- A named person for clinical questions and exceptions
What you receive
Deliverables the practice can review.
- A completed eligibility note for each scheduled visit
- Authorization records with reference numbers and decision dates
- A pre-visit exception list for the front desk
- Patient coverage summaries prepared for approved communication
- A weekly note on payer delays and recurring problems
A realistic workflow
How the work runs in a normal week.
The cadence is intentionally simple. Each checkpoint has a task, a record, and a clear handoff when something needs a practice decision.
Two to three days before the visit
Verify and document
Confirm coverage and benefits for scheduled patients, record the source and date, and flag anything the practice needs to discuss with the patient.
When a service needs authorization
Submit and track
Prepare the request, submit through the approved channel, and set a follow-up date. The record shows what was sent, when, and to whom.
The day before
Recheck the exception list
Confirm that pending authorizations and coverage issues have a resolution or an escalation owner before the patient arrives.
Weekly
Review payer patterns
Summarize repeated delays, missing information, or portal problems so the practice can adjust the workflow instead of rediscovering the same issue.
Quality controls
How the practice checks the work.
The assistant is not a black box. The role leaves a record that the practice can review, question, and correct.
- Each verification records the source, date, and person who checked it
- Authorization numbers are stored in the same place every time
- Pending items have a follow-up date and an escalation owner
- The exception list is reviewed before the schedule is finalized
Boundaries
What stays with the practice.
A clear boundary protects the patient relationship and keeps the administrative role focused.
- The assistant does not determine medical necessity or select the clinical service
- Coverage estimates are administrative preparation, not a guarantee of payment
- Clinical information sent to a payer follows the practice's approved process
- The practice approves any patient communication about cost or coverage
Common starting points
Where practices usually begin.
These are illustrative operating scenarios, not client case studies. They show how the role is scoped when the queue is already behind.
The Monday schedule
A practice starts the week with 45 scheduled visits and no pre-visit coverage review. The assistant works the list in priority order and gives the front desk a short exception sheet.
The pending authorization
An authorization has been pending for a week. The assistant documents the submission, checks the portal, records the payer response, and prepares the item for the practice's clinical reviewer.
The recurring payer problem
A payer repeatedly requests the same missing document. The weekly summary surfaces the pattern so the practice can update its submission checklist.
Questions before you start
Practical answers, without the sales language.
If a question is not answered here, bring it to the consultation. We will tell you if the workflow is not a fit.
Is this the same as billing?
It overlaps, but the focus is earlier in the visit: coverage, benefits, and authorization before the service. Billing follow-up handles the claim after the encounter.
Can the assistant talk to patients about coverage?
Only within the practice's approved script and policy. The assistant can prepare information and make approved administrative contacts, but the practice decides what is communicated and how.
What happens when a payer denies an authorization?
The assistant documents the denial and prepares the information for review. The clinical reviewer decides whether to appeal, adjust the service, or take another route.
Do you guarantee that every visit will be covered?
No. Verification reduces avoidable surprises, but payer rules, benefits, and medical necessity decisions can change. We document what was checked and escalate what is unresolved.
Start with one workflow
Ready to scope insurance verification and prior authorization?
Bring the queue, the systems, and the boundaries you already know. We will help turn them into a defined administrative role.