Eligibility Verification
Coverage and benefits verified before the date of service, so a visit is billable before it happens.
Eligibility Verification
Front End of the revenue cycle
Where it sits
- Front EndThis service
- Mid Cycle
- Back End
- Intelligence
Patient Access. Everything that happens before the encounter is billable.
What is included
- Coverage verification
- Benefits verification
- Insurance discovery
- Works inside your existing systems
- Scope and reporting agreed up front
- Engage it alone or with the full cycle
The service
What Eligibility Verification involves.
Eligibility is the cheapest denial to prevent and the most expensive to discover late. A coverage problem found before the visit is a phone call; found after, it is a write-off.
The revenue cycle
One part of an end-to-end cycle.
Every stage hands work to the next, which is why Kitronixe looks at the whole cycle even when you engage one part of it.
Where Eligibility Verification sits
Front End: Patient Access
- 01Patient Scheduling & Pre-Registration
- 02Eligibility & Benefits Verification
- 03Prior Authorization
Patient Scheduling & Pre-Registration
Demographic and insurance capture before the visit.
Reporting, Analytics & Revenue Integrity
KPI dashboards and revenue integrity review.
Patient Billing & Collections
Clear patient statements with online payment.
A/R Follow-Up & Recovery
Ageing buckets prioritised to cut days in A/R.
Denial Management & Appeals
Root-cause analysis stops preventable denials.
Payment Posting & Reconciliation
ERA/835 and EOB posting with accurate balances.
Eligibility & Benefits Verification
Real-time coverage, copay and deductible checks.
Prior Authorization
Pre-certification and payer approval secured.
Charge Capture
Every charge captured before the claim goes out.
Medical Coding
Coded to documentation, then checked before the claim goes out.
Claim Scrubbing & Submission
Clean EDI 837 claims sent to the clearinghouse.
RCM
Process
Patient Scheduling & Pre-Registration
Demographic and insurance capture before the visit.
Eligibility & Benefits Verification
Real-time coverage, copay and deductible checks.
Prior Authorization
Pre-certification and payer approval secured.
Charge Capture
Every charge captured before the claim goes out.
Medical Coding
Coded to documentation, then checked before the claim goes out.
Claim Scrubbing & Submission
Clean EDI 837 claims sent to the clearinghouse.
Payment Posting & Reconciliation
ERA/835 and EOB posting with accurate balances.
Denial Management & Appeals
Root-cause analysis stops preventable denials.
A/R Follow-Up & Recovery
Ageing buckets prioritised to cut days in A/R.
Patient Billing & Collections
Clear patient statements with online payment.
Reporting, Analytics & Revenue Integrity
KPI dashboards and revenue integrity review.
What is included
Everything in Eligibility Verification, handled by specialists.
Coverage verification
Confirmed with the payer ahead of the date of service.
Benefits verification
Deductible, co-insurance and visit limits established up front.
Insurance discovery
Where applicable, finding coverage the patient did not report.
Reporting
Measured the same way, every month.
Whatever part of the cycle Kitronixe runs for you, reporting is set against the same core measures, so performance is something you check rather than something you are told.
Days in A/R
How long, on average, a billed charge waits before it is paid.
Commonly cited target
Under 35 days
First-pass denial rate
The share of submitted claims a payer refuses on first adjudication.
Commonly cited target
Under 5%
Clean claim rate
The share of claims accepted on first submission, with no rejection or rework.
Commonly cited target
Above 96%
A/R over 90 days
The share of outstanding receivables that is more than 90 days old.
Commonly cited target
Under 12%
Targets are commonly cited reference points, not licensed benchmark data and not Kitronixe results. Treat them as directional: what is realistic depends on specialty, payer mix and where a practice is starting from.
Revenue cycle performance
Illustrative view of the measures Kitronixe reports against
$1.24M
Net collections, TTM
32.4
Days in A/R
6.1%
Denial rate, first pass
96.8%
Clean claim rate
Collections
Last 12 monthsClaim quality
This month- Clean96.8%
- Pending2.1%
- Denied1.1%
A/R by age
$1.34M outstanding- 0-30 days$841K
- 31-60 days$310K
- 61-90 days$128K
- 90+ days$64K
Denials by cause
Share of denials- Eligibility31%
- Authorization24%
- Coding19%
- Timely filing14%
- Other12%
Recovery opportunities
Open- UnderpaymentsAgainst contracted rates$48,500
- Appealable denialsWithin appeal window$26,400
- Unbilled encountersApproaching timely filing$9,750
Payer performance
Average days to pay- Commercial A28 days
- Commercial B41 days
- Medicare19 days
- Medicaid52 days
Collections density
By weekdayYour systems
Works alongside the systems you already use.
Kitronixe works inside the systems your practice already runs. There is no migration, nothing to replace, and no new system for your team to learn.
Kitronixe team
Working in your systems, with the access you grant.
- No migration
- Nothing replaced
- Your data stays put
- EHRWhere documentation and encounters live.
- Practice managementScheduling, charges, claims and patient accounts.
- ClearinghouseClaim submission, edits and rejections.
- Payer portalsEligibility, claim status, appeals, enrollment.
- RemittanceERA and EOB files, and the deposits behind them.
- ReportingThe reports and exports your team already reads.
Questions
Answers before you ask.
What practice owners and managers usually want to know before they start.
Do you work inside our existing systems?
Yes. Kitronixe works in your EHR and practice management system rather than requiring a migration. Your data stays where it is.
How long does a transition take?
It depends on volume and how many payers are involved. We transition in stages rather than all at once, so nothing stops while the changeover happens.
What do you report on?
Days in A/R, denial rate, clean claim rate and net collection rate, monthly and against an agreed baseline. If performance slips you will see it in a report before you hear it in a meeting.
Revenue Leakage Calculator
See where your own numbers say revenue is leaking.
Enter the figures from your own reports and the calculator shows an estimated range for each category of loss, with the arithmetic behind it. It does not assume a denial rate for you, and it never counts the same dollar twice.
What you will enter
- Monthly collections and appointment volume
- Your denial rate and clean claim rate
- Days in A/R and how your A/R is aged
- Payer mix, no-show rate and patient balances
It runs in your browser. Nothing you type is sent to Kitronixe, and there is no email gate. Results are estimates, shown as ranges.
Keep exploring
More across the cycle.
- Front End
Prior Authorization
Authorizations requested, tracked to approval, and checked for expiry before the service is delivered.
Learn more about Prior Authorization - Front End
Credentialing
Provider credentialing, payer enrollment, recredentialing, CAQH maintenance and EFT/ERA enrollment.
Learn more about Credentialing - Front End
Staffing & Workforce Services
Administrative and revenue-cycle workforce support for front-desk, eligibility, authorization, billing, A/R, denial, posting and reporting workflows - within an agreed scope.
Learn more about Staffing & Workforce Services
Start with your actual numbers.
We will look at what your revenue cycle is really doing before suggesting what to change. No obligation, and you keep the findings either way.