Prerequisites
- Eligibility (270/271) enabled through your clearinghouse or EHR
- The patient’s insurance card, or the member ID and payer
- A place in the chart to store the response
The two-check rule
1
Check at scheduling
As soon as the appointment is booked. This gives you days to resolve a problem before the visit, time to call the patient, get corrected information, or reschedule.
2
Check again at check-in
Coverage lapses, plans change at the start of the year, and employment ends. A check run three weeks ago is not evidence of coverage today.
Reading the 271
The response carries more than “active” or “inactive.” What to extract:
Estimate from the 271, not from the card. Insurance cards go stale — plans change at the start of the year while the card in the patient’s wallet does not. Point-of-care overcollection driven by reading the card is the leading cause of patient credit balances. See Refunds and credit balances.
When to call anyway
The 271 is not complete. Call the payer or check the portal when:- Authorization requirements are unclear — the 271 often doesn’t reliably report them per procedure
- The service is high-cost, and you want certainty
- The plan has a carve-out — behavioral health, imaging, lab, or pharmacy administered by a different entity
- The response is ambiguous or the payer doesn’t support real-time 270/271
- Coordination of benefits looks complicated — multiple coverages, Medicare secondary, workers’ compensation
- The patient’s information doesn’t match the payer’s record
Documenting the check
Save the 271 response to the encounter. Not a note saying “eligibility verified.” The actual response, with its date and timestamp. When a payer later denies for eligibility, the saved 271 showing active coverage on the date of service is your strongest appeal evidence. A staff note is not. See File appeals. Also record, for phone verifications: the date, the representative’s name, the reference number, and what you were told.Batch eligibility
For high-volume practices, run eligibility for tomorrow’s entire schedule in one batch each morning, and work only the exceptions. Most clearinghouses support batch 270 submission, and it turns a per-patient task into a 20-minute daily review.🦴 PT/Chiro, also check the visit authorization count remaining, not just coverage. Most payers authorize a limited number of visits, and exceeding it without a new authorization is a denial. This is a per-episode tracking problem, not just a per-visit check.
🦷 Dental, check the annual maximum remaining, frequency limitations for the planned service, and any waiting period. A patient with active coverage who has exhausted their annual maximum owes the full amount.
Steps
1
Enable real-time 270/271 for your payer mix
Confirm coverage with your clearinghouse. Not every payer supports real-time; know which don’t.
2
Build the scheduling-time check into the booking workflow
Make it a required step, not an optional one.
3
Run a batch each morning for the next day's schedule
Work the exceptions; have the front desk call those patients today.
4
Re-check at check-in
5
Save the response to the encounter
6
Estimate patient responsibility from the 271
And collect it. Under-collect on uncertainty.
7
Escalate the ambiguous cases to a phone call
And document the call.
Verify it worked
- Real-time 270/271 enabled for the payer mix
- Check at scheduling is a required workflow step
- Daily batch running for the next day
- Re-check at check-in
- 271 responses saved to the encounter
- Point-of-care estimates derived from the 271, not the card
- Phone verifications documented with name and reference number
- Eligibility denials tracked as a root-cause category