Insurance eligibility & coverage verification
Eligibility Coverage Verification
Coverage is not just on or off. Champ agents help you get real-time portal visit limits, prior auth rules, documentation requirements and patient cost estimate.
Trusted by healthcare companies
40%
of verifications still worked by hand in portals
1 in 4
claim denials start with eligibility errors
$18.4B
left on the table in eligibility every year
The operational bottleneck
Your clearinghouse says “active.” Your team still does the rest.
A 270/271 response confirms coverage, but rarely the copay, remaining deductible, or authorization rule for the service on the schedule. So staff fill the gap by hand, one portal and one patient at a time.
Bring us your workflowStaff log into payer portals patient by patient to find the benefits the eligibility response left out
Eligibility errors surface as denials weeks after the visit, when the fix is rework instead of a quick check
Patients learn what they owe at checkout, and every surprise makes collection harder
Medicare, Medicaid, and managed-care plans each need a different system, so the hardest coverage takes the longest
The production workflow
One continuous operation, not another disconnected tool.
Champ coordinates browser, document, API, voice, and human steps around the outcome your team is responsible for.
- 01Validate the patient and appointment
Confirm demographics, subscriber details, payer, service dates, provider, and scheduled procedure before verification begins.
- 02Check every available source
Run the eligibility transaction, then continue into Medicare, state Medicaid, managed-care, and payer systems when the response does not answer the operational question.
- 03Resolve the program-specific path
Normalize coverage and benefits, identify the responsible plan, evaluate approved program criteria, collect supporting evidence, and determine the next enrollment or referral step.
- 04Write back and resolve exceptions
Update the EHR or practice-management system, recheck on schedule, and route conflicting or incomplete results with the evidence attached.
Why it stays reliable
Built around the work, not a brittle integration map.
Your systems can stay exactly where they are. Champ operates across them, records what happened, and improves the workflow as the process changes.
Works with your stack
If your team can access it, Champ can work in it.
Use APIs where they are dependable and managed browser agents everywhere else. No rip-and-replace required.
CHANGE THE OPERATING MODEL
Three ways to run eligibility. One that finishes.
What each approach returns once the answer is not in the transaction.
| What the check has to answer | EDI / clearinghouse270/271 or an eligibility API, on its own | Manual follow-upStaff working payer portals behind the response |  ChampOne workflow, operated in production |
|---|---|---|---|
| Active coverage and responsible plan | Yes. Returned in seconds | Yes. Confirmed by hand | Yes. Confirmed and rechecked on schedule |
| Benefits, authorization, and program detail | No. Generic or missing from the response | Yes. Looked up payer by payer | Yes. Completed in the same run |
| More than one source reconciled | No. One response, one opinion | No. Too slow to run routinely | Yes. Sources compared, conflicts resolved |
| Portal, phone, and fax follow-up | No. Out of scope | Yes. The bulk of the work | Yes. Browser, voice, and document agents |
| Evidence behind the answer | Partly. The raw 271 only | Partly. Notes, when there is time | Yes. Screenshots, timestamps, and reference numbers |
| What more volume costs you | Partly. The same gap, more often | No. More headcount | Yes. More completed verifications |
See it run on your payers.
Tell us which payers and systems you verify against. We'll walk you through the workflow on them.
HIPAA · BAA available · Live in 2 weeks · Works in existing portals and EHRs
Insurance eligibility & coverage verification FAQ
Questions healthcare operators ask first.
You have more questions?
Send us an emailMore healthcare workflows
One platform across the back office.
Champ runs the same way across the rest of revenue cycle and compliance operations.
Stop re-keying benefits by hand.
Champ verifies every patient before the visit and sends your team only the exceptions.
HIPAA · BAA available · Live in 2 weeks · Works in existing portals and EHRs