Insurance Eligibility & Prior Authorization
Verify Coverage and Secure Authorizations Before Every Visit
We confirm eligibility and benefits, estimate patient responsibility and obtain prior authorizations in advance, which prevents front-end denials.
- Eligibility & benefits checks
- Prior authorization support
- Fewer front-end denials
Free practice audit & ROI estimate within 24 hours. No obligation.
Overview
Stop Denials Before They Happen
A large share of claim denials start at the front desk: inactive coverage, wrong payer information, missing referrals or services that needed prior authorization. Each of these is preventable, but only if someone checks before the patient is seen.
KGF Health verifies insurance eligibility and benefits ahead of scheduled appointments, documents copays, deductibles and coinsurance, and identifies services that require prior authorization. Our team then prepares and submits the authorization request, follows up with the payer, and records the approval so your claim goes out clean.
- Pre-visit eligibility and benefits verification
- Patient responsibility estimates
- Prior authorization submission and follow-up
- Referral and authorization tracking
Coverage confirmed before the patient arrives
What's Included
Front-End Revenue Protection
Clean claims start with accurate patient and coverage information.
Eligibility Verification
Active coverage, plan type and payer details confirmed through payer portals and clearinghouses.
Benefits Verification
Copays, deductibles, coinsurance, visit limits and out-of-network rules documented for your staff.
Prior Authorization Support
We identify services that need authorization, prepare requests with clinical documentation and submit them.
Payer Portal Follow-Up
Our team tracks pending authorizations through payer portals and phone follow-up until a decision is made.
Patient Estimates
Clear estimates of patient responsibility so your front desk can collect at the time of service.
Authorization Tracking
Approved units, dates and expirations tracked so renewals are requested before they lapse.
Our Process
Our Verification & Authorization Workflow
Built around your schedule so every patient is cleared before they arrive.
Review the Schedule
We pull upcoming appointments and identify patients that need verification.
Verify Coverage
Eligibility and benefits are checked and documented in your system.
Request Authorization
Services that need prior authorization are submitted with required documentation.
Confirm & Track
Approvals are recorded and tracked; your team is alerted to any issue before the visit.
Why KGF Health
Why Practices Choose KGF Health for Front-End Support
Fewer surprises for your patients and fewer denials for your practice.
Fewer Front-End Denials
Coverage and authorization problems are caught before the claim is ever created.
Better Point-of-Service Collections
Accurate estimates help your staff collect patient balances up front.
Less Front-Desk Workload
Your staff stops spending hours on hold with payers.
HIPAA Compliant
All patient information is handled securely and confidentially.
Specialty Knowledge
We understand authorization rules for imaging, procedures, therapy and specialty drugs.
Responsive Support
Same-day communication when a patient's coverage needs attention.
Get Started
Get a Free Front-End Workflow Review
Tell us about your practice and we will show you where eligibility and authorization gaps may be causing denials.
Free Denial Source Review
Find out how many denials start at the front desk
Workflow Recommendations
Practical steps to clear patients before every visit
HIPAA Compliant
Your data is always secure and protected
Fill in your details and we’ll be in touch within 24 hours.
FAQ
Frequently Asked Questions
Have more questions? Our billing specialists are happy to help.
We typically verify coverage ahead of scheduled appointments and re-check when needed, for example for recurring visits or when a patient’s plan changes. The exact timing is set around your scheduling workflow.
It depends on the payer and plan, but common examples include advanced imaging (MRI, CT, PET), surgical procedures, certain specialty drugs, durable medical equipment and some therapy services. We check payer requirements for each service.
Yes. We track approved visits, units and expiration dates and request extensions or renewals before the authorization runs out.
Yes. Our team works inside your existing practice management, EHR and payer portals and documents everything where your staff can see it.
We notify your team right away, help gather any additional clinical documentation and support peer-to-peer requests or appeals where appropriate.
Explore More
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Accurate, same-day posting of ERAs, EOBs and patient payments with full reconciliation.
Appeals & Reconsiderations
Well-documented appeals and reconsiderations that recover revenue from denied and underpaid claims.
Revenue Cycle Reporting
Clear billing, collection and A/R reports that show exactly how your practice is performing.
Free Practice Audit
Clear Every Patient Before They Walk In
Let KGF Health handle eligibility and prior authorizations so your claims go out clean the first time.