facebook Prior Authorization, Eligibility, and Benefits Verification Services

Medical Billing Services

Prior Authorization, Eligibility, and Benefits Verification Services

Let us verify benefits and eligibility before filing insurance claims. We don’t just process claims and manage denials in our medical billing services. We also make the claims process much easier by taking steps to verify benefits and eligibility ahead of time.

  • Checking patient schedules
  • Entering patient demographic information
  • Verifying patient coverage
  • Verifying patient benefits
  • Initiating prior authorization requests
X Graphic X Graphic X Graphic X Graphic X Graphic Calendar Icon

Start seeing more profitability in as little as 5 days

One phone call is all it takes to identify whether our services are right for your practice. We can start serving you in as little as one week.

100% Free Practice Review

(888) 394-7815

Full Name(Required)

See if we’re a good fit.

Our Prior Authorization, Eligibility, and Benefits Verification Services

In order to reduce the risk of having a claim denied and then needing to refile costs valuable time. To avoid this, we check that a patient has the insurance coverage necessary for a particular claim to be filed.

Woman working at computer with files nearby

Prior Authorization

Prior authorization is when an insurance company gives approval for a treatment or medication prior to the patient actually receiving it. Obtaining prior approval from an insurance company can help to reduce any risk of the claim being denied later. The insurance company would have already approved that treatment.

Benefits Verification

Before treating a patient, we’ll check that their insurance benefits will cover that particular medication or treatment. Knowing in advance that a certain treatment is included in a patient’s coverage can also help to reduce the risk of a denial later on.

Coverage Verification

Coverage verification is different from benefits verification. Benefits verification checks what a patient’s insurance will cover. Coverage verification checks that the patient had valid insurance at the time of the treatment. The timing of insurance coverage plays just as big a role in determining a claim’s viability as whether or not a treatment is covered.

Data Entry Prior to Patient Visits

Ideally, as much of the verification process is completed prior to a patient visiting. This means coordinating with patient schedules and gathering insurance information for verification. Prior authorization may not be possible until the treatment is known, but as much verification as possible should be done prior to the patient’s arrival in order to speed up the collections process.

Get a more profitable practice

Increase collections by 15%

Inhouse Medical Billing

$1,200,000 revenue

– $45,000 biller salary

– $40,000 secondary biller salary

– $23,750 Benefits and Overhead @ 25% of salary

– $3,000 Cost of software and hardware for billers

– $1,200 Cost of Postage

$1,087,000 in net collections

Average billing expense of 10.25% of collected revenue

Outsourced Medical Billing

$1,400,000 17% increase in top line collected revenue

– $77,000 5.5% of collected revenue

$1,323,000 in net collections

Average billing expense of 5.5% of collected revenue plus the added collective revenue from outsourcing

Benefits of Prior Authorization, Eligibility, and Benefits Verification Services

Applying for prior authorization and verifying patient coverage and benefits can help to speed up the claims process. This means receiving collections faster and reducing the risk of a claim being denied by a payer.

Reduced Risk of Claim Denials

Obtaining prior authorization for treatment from an insurance company and verifying patient coverage can help to reduce the risk of the payer denying the claim. This ensures a timelier payout of collections you’re owed because you’ll know ahead of time that a particular treatment is approved.

Faster Collections

If we verify patient insurance coverage and benefits prior to their arrival at your practice, the time it takes to code and file a claim is greatly reduced. Outsourcing already decreases the amount spent in A/R by up to 19 days and this pre-approval and verification process contributes to the speed at which we can get you your collections.

Flexibility to Meet Insurance Company Requirements

We’ve worked with many different insurance companies. This means that we’re able to tailor our claims filing process to meet the requirements of each in order to maximize collections and reduce the amount of time it takes to receive them.


What our clients are saying

"I would recommend Quest without reservation."

"We were a busy Urological group with four clinicians and had just been informed by our Medical Billing Service that they were closing their operation. We needed to associate with a new service quickly. We heard about Quest through our IPA, an organization where I am on the board. Quest was interested in working with more practices in our area and had a very good local and national reputation.
Adam and his team promptly visited with us. We had also met with other services but it became clear that Quest would be our choice. Quest was knowledgeable, hands-on, transparent, flexible, and ready to move ahead quickly. As promised, things did move ahead quickly and seamlessly.
Things have continued to work out well. In retrospect, Quest has been far superior to our previous billing service. It has been a pleasure to work with Adam and his team. I would recommend Quest without reservation."

Read More Headshot

Roderick Crocker, MD

Urologist, Cambridge Urological Associates

"They did a great job with our billing."

Dr. Duncan Gill

"…saving our practice tens of thousands of dollars."

"Quest National Services and Adam have been vital to the success of the Highland OBGYN practice. Quest National was able to take on our account in a very quick manner and has transitioned our practice from one software to another with little down time ultimately saving our practice tens of thousands of dollars. The team at Quest National have been the partners my growing OBGYN practice has needed. Most important for me is their ability to provide us redundancy when we otherwise wouldn’t have it. I couldn’t be more thankful for their dedication to our practice."

Read More Headshot

Mark Lowney

OB/GYN, Southcoast Health

"Worked with our existing software so that we didn’t have to make expensive changes"

"My husband and I have a small practice but we were looking for a medical billing company to consult us. We originally started with a local company with some satisfaction. However, our biggest problem was that they wanted us to change our existing EMR to software that they worked with. Quest National Services worked with our existing software so that we didn’t have to make expensive changes to our infrastructure. That saved us a lot of time and headache. I would definitely say that was one of the main reasons for why we switched and why we continue to work with Quest. As a small practice, they helped us without draining our resources."

Read More Ariana headshot

Adriana C.

"I was impressed almost immediately by their transparency and consistent communication"

"As an administrator of a multi specialty clinic, I was looking for a service that provided timely and consistent communication. I found in prior engagements with our prior 2 billing companies neither provided the level of communication or transparency our principals expected. When I was introduced to Quest I was impressed almost immediately by their transparency and consistent communication. We've been with them now 5 months and are so happy we made the move."

Read More Default headshot

Roger P.

"Quest has made the process so transparent and allowed us to increase our profits"

"Our company made the decision to outsource our medical billing to Quest and we have been incredibly pleased with the results. The knowledge, dedication, and customer service provided by their team is truly first class!
When we came to Quest, we had a hard time recovering our A/R and ensuring the accuracy of our billing. Quest has made the process so transparent and allowed us to increase our profits, while also pointing out and assisting in areas of improvement.
I really appreciate the work of Nancy and her team, and the responsiveness of the CEO, Adam. They both always find the time to address any questions or problems we are having!"

Read More Default headshot

Joseph D.

"Quest lowered our time in accounts receivable by close to two weeks"

"Quest has made a huge difference in our business, even within the limited amount of time that we’ve been using their services. We kept our current EMR and, in less than six months, Quest lowered our time in accounts receivable by close to two weeks! I couldn’t believe it. We’ve been very pleased with the services and responsiveness of their staff so far. We were able to get reimbursed faster which was so important. Moreover, Quest took over the burden of dealing with aging receivables so we could focus more on business. They offered so many options and services and we were able to find the perfect solution for us. Thanks to Adam and everyone at Quest!"

Read More Default headshot

Peter H.

"The team is knowledgeable, efficient and very timely"

"Moving my billing needs to Quest National has been the best decision for my business that I have made! From the initial meeting communication has been outstanding. The team is knowledgeable, efficient and very timely. I could not be happier and I am recommending them to all my peers. Thank you Lesley and Nancy - I have gone back to seeing my patients and no longer have to worry or follow up on the billing part of my practice because QNS has me covered."

Read More Default headshot

Bridget R.