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Eligibility & prior-auth checklist
Denials that start at the front desk are the cheapest to prevent. Score your pre-visit verification against the ten checks that stop eligibility, coverage, and authorization denials before the claim goes out.
10 front-end checks Readiness score Maps to CARC codes
All tools
Pre-visit verification checks
Eligibility readiness
0%
High denial risk
0 of 10 checks complete.
Open denial risks
- CO-27 — coverage terminated / expired
- CO-242 — services not provided by network provider
- CO-31 — patient cannot be identified as insured
- CO-96 — non-covered charges
- CO-197 — precert / authorization absent
- CO-183 / CO-197 — referral requirement not met
- CO-22 — may be covered by another payer per COB
- CO-140 — patient/insured health ID number and name mismatch
- CO-50 — not deemed a medical necessity
- CO-29 — time limit for filing has expired
Educational reference. Requirements vary by payer and plan — some services need referral and authorization, others neither. Use the denial-code lookup to work any code these checks are meant to prevent.
Stop denials at the source.
Aethera builds front-end verification into every claim so eligibility and auth denials never reach your A/R. See where yours are leaking.
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