02Eligibility

Eligibility you can actually act on.

One confidence-scored answer, checked across more than one source — so a covered patient never comes back 'not covered.'

Eligibility resultForesight
Multi-source eligibility Confidence: High
Claim.MD Stedi
Needs adjudicationCarve-out detected → Optum
Coverage restrictions
CoveredTier 2
Prior authorization required
Two clearinghouses, cross-checked and reconciled into one answer with the caveats behind it.
Multi-source

More than one source, cross-checked

A single eligibility response is often thin or wrong. We run the check across more than one clearinghouse and reconcile the results into one answer with a confidence level — sources agree, high confidence; they don't, we say so.

Cross-checked. Independent sources corroborated into a single result.
Confidence-scored. The answer carries how sure we are, not a bare yes/no.
No re-enrollment. Runs across clearinghouses without re-enrolling the payer.
Carve-outs

It catches the benefit the medical check misses

Behavioral-health benefits are often carved out to a separate vendor the standard check never sees. We detect the carve-out, route to the right payer, and read per-service coverage — so treatment-specific coverage isn't mislabeled.

Coordination of benefits

Primary, secondary, tertiary — settled up front

When a patient carries more than one plan, we resolve the payer order before anything is billed and flag conflicts early. Once the primary pays, the secondary claim generates itself with the primary's adjudication attached.

Benefit order
Payer order resolved before billing; the secondary claim starts itself when the primary adjudicates.
Honest by design

An estimate up front, then the exact number

For some treatments the true patient cost isn't knowable until the claim adjudicates. We surface a confidence-scored estimate before the visit, then the exact figure once it processes — not a false 'covered.'

See it on your claims

Bring a week of claims.
We'll show you the layer.

In under 30 minutes we'll walk this through on your data — what we'd catch, fix, and recover on day one.

This capability

AreaEligibility
Runs onYour EHR
ReviewTunable · audited