Docs / Setup
Insurance verification
How the Insurance Verification agent checks coverage before each visit (US clinics).
The Insurance Verification agent checks each patient's insurance a few days before their visit, so a lapsed or wrong policy is fixed before the visit instead of becoming a denied claim.
How a check works
- A visit is booked. The agent plans a check 3 days before it (change this in the agent's Settings). A visit sooner than that is checked straight away.
- It asks the payer through a real-time eligibility check (X12 270/271, through the Stedi clearinghouse).
- The result is saved on the patient's record with the plan, copay, coinsurance and remaining deductible when the payer returns them. The Insurance page shows every upcoming visit and its status.
| Result | What happens |
|---|---|
| Active | Nothing more to do. An active result from the last 24 hours isn't checked again. |
| Not active or not found | Your team gets an Insurance problem item, and the patient is asked for their current details (this message can be set to need approval first). |
| No insurance on file | Same as above: staff are told, and the patient is asked. |
| Payer error | Retried for about two hours. If it still fails, staff are told; the patient isn't bothered with a problem that isn't theirs. |
| Self-pay | Not checked. |
New details
When a patient sends new insurance details (in a conversation, or staff edit them), those details are checked again before the visit, once. If details change while a check is waiting, the newest details are the ones checked.
Connecting the clearinghouse
Open your pack's Integrations tab and connect Insurance clearinghouse. Until it's connected the agent doesn't check anything, and its setup shows what's missing.
India
Insurance in India mostly goes through TPAs and cashless pre-authorisation, not real-time eligibility checks. Indian clinics can record a patient's insurer and policy number, and staff confirm cover at the visit. Cashless pre-authorisation through NHCX is planned.
Staff checks
On the Insurance page, Check now runs a check immediately for any patient, using the same steps and keeping the same record.
Something missing or unclear? Ask in the chat at the bottom right, or talk to the Saient team.