At Virtual Sourcing Solutions, we deliver fast, accurate Eligibility & Benefits Verification (EBV) so your front office, billing team, and patients always know what’s covered—before the date of service. Fewer surprises, fewer reworks, faster reimbursements.
What We Do
- Real-Time Eligibility Checks – Verify active coverage, plan type, and effective dates via payer portals/clearinghouses.
- Benefits Breakdown – Copays, coinsurance, deductibles (met/remaining), OOP max, visit limits, prior-auth triggers.
- Plan & Policy Rules – Referral requirements, network status, pre-existing or frequency limits, medical policy notes.
- Coordination of Benefits (COB) – Primary/secondary order validation to avoid payment delays.
- Provider & Location Validation – NPI/TIN, site-of-service, in-network status confirmation.
- Documentation & EHR Updates – Post verified details, eligibility snapshots, and notes directly into your system.
- Patient Cost Estimates – Clear, upfront estimates to reduce bad debt and improve satisfaction.
- Exception Handling – Same-day escalations for unclear responses, name/DOB mismatches, and portal downtime.
Who We Help
Hospitals • Physician Groups • Imaging & Labs • Ambulatory Surgery Centers • DME/HME • Behavioral Health • Dental & Allied Providers • RCM/Billing Companies
Why Choose Virtual Sourcing Solutions?
- Accuracy First: Dual-check workflow and standardized templates cut front-end errors.
- Speed & Scale: High-volume same-day verifications with predictable turnaround (SLA-backed).
- Denial Prevention: Catch auth/referral requirements and benefit limits before scheduling.
- Secure & Compliant: NDA, least-privilege access, encrypted transfers, audit-ready logs.
- Flexible Coverage: Overflow support, after-hours/weekend teams, or full EBV outsourcing.
Our Proven Process
- Order Intake – Capture demographics, payer info, service/CPT/ICD, site of service.
- Eligibility Query – Real-time portal/EDI check with secondary validation if needed.
- Benefits Mapping – Document copay, coinsurance, deductible status, visit/quantity limits.
- Risk Flags – Identify auth/referral triggers, OON risks, COB conflicts, benefit caps.
- EHR/PM Update – Post all details + time-stamped proof (screenshots/eligibility PDF).
- Patient Estimate – Optional estimate generated and shared per your policy.
- Daily Reporting – Worklist status, TAT, exception queue, and denial-prevention insights.
Business Outcomes
- Fewer Front-End Denials – Cleaner claims and higher first-pass yield.
- Lower A/R Days – Less rework, faster payments.
- Better Patient Experience – Clear costs and coverage reduce surprises.
- Operational Clarity – Standardized notes and proof for audits.
Platforms & Payers We Work With
Epic • Cerner • Athenahealth • eClinicalWorks • NextGen • AdvancedMD • Kareo/Tebra • DrChrono • Practice Fusion • Availity/Change Healthcare portals • Commercial & Government payers
Deliverables You Receive
- Eligibility snapshot/proof, full benefits breakdown, risk flags (auth/referral/OON/limits), EHR notes, and weekly KPIs (TAT, accuracy, exception rate).
Call to Action
Stop eligibility surprises before they become denials.
Book a free consultation with Virtual Sourcing Solutions to streamline your Eligibility & Benefits Verification process today.