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.
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.
Turn these Eligibility Checklist insights into recovered cash
Tired of CO-27 and CO-197 auth denials? Aethera performs automated pre-visit eligibility verification across 900+ payers. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free, with guaranteed under-48-hour findings.
Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.
Upload your aging report for instant benchmark comparisons against MGMA standards and recoverable cash projections.