Insurance verification & authorisation · Durable medical equipment
Authorise every order before it ships.
A CPAP order arrives with eligibility unchecked, a sleep study that misses the LCD criteria, and no prior auth submitted. Ship it and the claim denies.
The reality
Verification is a coverage-criteria problem.
Every HCPCS item has its own coverage rules — Medicare LCDs, capped-rental terms, and payer-specific PA requirements. A CPAP needs a qualifying AHI and a compliant face-to-face. Verifiers chase eligibility, benefits, and auth across payer portals one order at a time, and a missed step becomes a denied claim after the equipment is already out the door.
The operator owns verification to authorised. It checks eligibility and benefits against the specific HCPCS code, confirms the order meets the LCD coverage criteria, submits the prior authorisation with supporting documentation, and tracks it to approval before the order is cleared to ship.
How the operator runs insurance verification & authorisation
Order DME-6612 · E0601
verifying- Medicare eligibility confirmed active
- Capped-rental benefit checked
- Secondary payer COB — verifying
01Verify eligibility
Checks active coverage and benefits for the specific HCPCS code, confirming deductible, copay, and capped-rental terms.
Order DME-6612 · LCD Check
checking- AHI 22 — meets qualifying threshold
- Face-to-face note on file
- Compliant diagnosis verified
02Confirm coverage criteria
Checks the order against the LCD — qualifying study, face-to-face, diagnosis — and flags any gap before auth.
Auth PA-88017 · Pending
tracking- PA submitted with clinical docs
- Payer received, reference logged
- Approved — order cleared to ship
03Submit and track auth
Files the prior authorisation with documentation, tracks it to approval, and clears the order to ship.
The outcome
−68% of verification work off the team
Authorise every order before equipment is shipped.
- Eligibility and benefits confirmed against the exact HCPCS code, every order
- LCD coverage gaps caught before submission, not after a denial
- Authorisation tracked to approval before the equipment leaves the warehouse
Common questions
Insurance verification & authorisation
- What does the Insurance verification & authorisation operator do?
- The operator owns verification to authorised. It checks eligibility and benefits against the specific HCPCS code, confirms the order meets the LCD coverage criteria, submits the prior authorisation with supporting documentation, and tracks it to approval before the order is cleared to ship.
- What impact does the Insurance verification & authorisation operator have?
- −68% of verification work off the team. Authorise every order before equipment is shipped.
- How does the Insurance verification & authorisation operator work?
- Checks active coverage and benefits for the specific HCPCS code, confirming deductible, copay, and capped-rental terms. Checks the order against the LCD — qualifying study, face-to-face, diagnosis — and flags any gap before auth. Files the prior authorisation with documentation, tracks it to approval, and clears the order to ship.
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