01Most common
Coordination of benefits
With 43 million Americans covered by multiple plans, incorrect payer sequencing drives 15 to 17 percent of all claim denials. We confirm primary, secondary, and tertiary payer order before the claim goes out.
Coverage discovery services
Coverage discovery services
Coverage discovery is the process of identifying active insurance a patient has but the provider has not captured. Up to 30% of patients classified as self-pay carry billable coverage that was never surfaced at registration. Our insurance discovery services find it, across Medicare, Medicaid, and commercial payers nationwide, before a claim is submitted, at the point of service, or on aged accounts already headed for write-off.
5-day onboarding | $0 setup | 50 states
The revenue hiding inside your self-pay accounts
The revenue hiding inside your self-pay accounts
$745B
U.S. hospitals have provided billions in uncompensated care over the past two decades, according to the American Hospital Association. A significant share of that total is not truly uncompensated. It is care delivered to patients who had active insurance that was never identified.
27%
Registration and eligibility errors remain the single largest denial category according to Change Healthcare analysis confirmed by MGMA. Each denied claim costs an average of $25 to rework, with administrative costs per denial reaching $57 in 2023 according to Aptarro data. Up to 65% of denials are never resubmitted at all. The claims age out, get written off, and the revenue disappears permanently.
Understanding the difference
Coverage discovery versus eligibility verification
The two terms describe different operations and solve different problems.
A
Eligibility verification
Confirms benefits on a plan the patient already provided. It starts with known insurance data and checks whether coverage is active for a specific service: copays, deductibles, referral requirements, and prior authorization needs. It runs at scheduling or check-in. It does not search for coverage the patient never mentioned.
B
Coverage discovery
Starts from the other direction. The patient has no insurance on file, or the information is incomplete, and we search payer databases to find active plans the provider does not know about. It queries state Medicaid systems, employer records, and commercial carriers. It runs pre-service, at registration, and post-service. It catches parent plans, dual-eligible coverage, workers' comp, VA benefits, and retroactive Medicaid.
Most billing operations run eligibility checks at scheduling. Few run coverage discovery at all. The accounts that carry hidden insurance, young adults still on a parent's plan, dual-eligible Medicare and Medicaid patients, workers' comp cases that were never flagged, are the ones that slip into the self-pay bucket and stay there.
Where we run discovery in the revenue cycle
Where we run discovery in the revenue cycle
We check for undiscovered coverage at three points, not one. Each catches revenue the others miss.
01
Pre-service discovery
Before the patient is seen, we query payer databases through 270/271 eligibility transactions to confirm active coverage, benefit limits, copays, deductibles, referral requirements, and prior authorization needs. Patients with no insurance on file are flagged for a full discovery sweep, cross-checking state Medicaid systems, employer records, and commercial payer databases to surface coverage before the appointment.
02
Point-of-service verification
At registration, we verify coordination of benefits to confirm primary, secondary, and tertiary payer order. COB errors are the leading cause of claim processing delays in practices with high dual-coverage volume. We catch payer sequencing problems here, before they become CO-22 denials downstream.
03
Post-service recovery
For accounts already classified as self-pay, we run batch sweeps against payer databases to find coverage that was missed at intake. Industry data shows a 10 to 30 percent hit rate on self-pay accounts, meaning one in ten to three in ten patients marked as uninsured actually have billable coverage at the time of service. We verify the match with an eligibility transaction, then route the account for claim submission, converting what was headed for write-off into a paid claim.
Six coverage gaps we identify and close
Six coverage gaps we identify and close
02Second gap
Medicaid and dual-eligible coverage
Many patients qualify for Medicaid but fail to report it, or do not realize they are dual-eligible for Medicare and Medicaid. We cross-check state and federal databases to identify QMB, SLMB, and full dual-eligible beneficiaries.
03Third gap
Undisclosed secondary and tertiary plans
Young adults still covered under a parent's plan, spouses who assume the provider automatically sees their secondary coverage, and workers' comp or VA benefits that were never mentioned at intake all fall into this category.
04Fourth gap
Out-of-network and HDHP identification
High-deductible health plans and out-of-network situations create billing complexity that standard eligibility checks miss entirely. We confirm plan type, deductible status, and network participation so claims route correctly before the visit.
05Fifth gap
Medicare Secondary Payer compliance
MSP rules determine when Medicare is not the primary payer. Employer group health plans, auto insurance, workers' comp, and liability situations all affect sequencing. We verify MSP status to prevent denials and comply with CMS billing requirements.
06Sixth gap
Retroactive and lapsed coverage
Medicaid coverage can activate retroactively and commercial plans lapse mid-month without notice. We verify coverage effective dates against dates of service, catching mismatches that would result in a denial or wrong collections.
Connected to the rest of your revenue cycle
Connected to the rest of your revenue cycle
Coverage discovery feeds directly into our medical billing, medical coding, credentialing, and AR recovery workflows. When we find coverage, the claim moves. It does not sit in a queue waiting for a handoff.
We integrate with your existing EHR and practice management system, including eClinicalWorks, Athenahealth, NextGen, Kareo, AdvancedMD, Epic, RXNT, Office Ally, and 30+ others. No system replacement. No staff retraining. Implementation is scoped during the free coverage audit at no extra charge.
eClinicalWorksAthenahealthNextGenKareoAdvancedMDEpicRXNTOffice Ally30+ others
Why practices choose Medbilling RCM for coverage discovery
Why practices choose Medbilling RCM for coverage discovery
Full payer search network
We search across Medicare (Parts A, B, C, D), Medicaid in all states, TRICARE, VA, workers’ comp, and commercial carriers from a single integrated platform.
Three-point discovery
Most providers only check eligibility at scheduling. We run discovery before the visit, at registration, and as a batch sweep on aged self-pay accounts, three points, not one.
HIPAA-compliant by default
All transmissions are encrypted. A Business Associate Agreement is executed before any patient data is accessed. Demographics are used solely for coverage identification and never shared.
No system replacement
Coverage discovery layers onto your current setup with no system replacement and no forced platform migration. Integration is scoped during the free coverage audit at no extra charge.
Coverage discovery questions we get asked
Coverage discovery questions we get asked
Direct answers for practices, hospitals, and billing teams evaluating coverage discovery.
What is coverage discovery in medical billing?
Coverage discovery is the process of finding active insurance that a patient has but the provider has not captured.
How much revenue can coverage discovery recover?
A significant portion of accounts classified as self-pay carry active, billable insurance at the time of service. Coverage discovery identifies those accounts and converts them into payer-billed claims, recovering revenue that would otherwise be written off.
When should coverage discovery run in the revenue cycle?
At three points: before the appointment for pre-service eligibility and discovery, at registration for coordination of benefits verification, and after service as a batch sweep.
What is coordination of benefits and why does it cause denials?
Coordination of benefits errors are a leading cause of claim denials. Each reworked denial adds significant administrative cost. Coverage discovery identifies COB gaps before claims are submitted, reducing rework and payer rejections.
How does coverage discovery reduce bad debt?
It identifies active insurance on accounts that were classified as self-pay, converting what would have been a patient collection or write-off into a payer-billed claim.
Does coverage discovery work with our EHR system?
Yes. We integrate with eClinicalWorks, Athenahealth, NextGen, Kareo, AdvancedMD, Epic, RXNT, Office Ally, and 30+ other EHR and practice management systems.
What payers do you search?
We search across Medicare Parts A through D, Medicaid in all states, TRICARE, VA benefits, workers' compensation, and commercial carriers.
Is patient data secure during coverage discovery?
All transmissions are encrypted and run through HIPAA-compliant channels. We execute a Business Associate Agreement with every client before any patient data is accessed.
How long does it take to see results from coverage discovery?
Pre-service discovery produces results before the patient visit. Post-service batch sweeps typically return discoverable coverage within the first two weeks of engagement.
How do I get started?
Request a free coverage audit. We analyze a sample of your self-pay accounts, identify recoverable coverage by payer type, and report back what we find.
Ready when you are
The free coverage audit is specific.
We pull a sample of your self-pay accounts and show your discoverable coverage by payer type, your coordination-of-benefits exposure, and your estimated recovery. You keep the findings whether or not you work with us. If you decide to move forward, engagement starts within two weeks with no setup fee and no long-term contract.
- Discoverable coverage by payer type from your self-pay accounts
- Coordination-of-benefits exposure report
- Estimated recovery dollar amount
- You keep the findings either way
- HIPAA-compliant, BAA signed before data moves
- No setup fee. No long-term contract.