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Medical Billing
Medical Billing
End-to-end medical billing from WNL RCM: daily charge entry, claim scrubbing, filing within 48 hours, payment posting, patient statements, and denial appeals.
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Service
Eligibility and Benefits Verification
Most denials are decided before the patient is ever seen. A plan that terminated last month, a service that needed prior authorization, a first name the payer has spelled differently — any one of them turns a routine encounter into rework. We verify coverage on every date of service so your front desk collects the right amount and your claims leave the office payable.
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Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
What we check on every date of service
Five things get confirmed before the appointment. Whether coverage is active on that specific date. Whether the patient name and date of birth match what the payer holds on file. What the patient actually owes in copay, coinsurance, and remaining deductible. What plan type is in force, because an HMO with no referral on file denies differently than a PPO. And whether the scheduled service carries a prior authorization requirement. Anything that fails gets flagged back to your scheduler with the specific problem named, not a generic exception.
Demographics are a payer-matching problem
Payers reject on identity mismatches more often than practices expect. A hyphenated surname entered without the hyphen, a subscriber ID transcribed with an O instead of a zero, a dependent listed under the wrong policy holder — each produces a rejection that has nothing to do with medical necessity and everything to do with data. Our verifiers compare your registration record against the payer response field by field and correct the practice management system directly, so the same mismatch does not repeat at the next visit.
Prior authorization, caught before the visit
Authorization requirements vary by payer, by plan, and sometimes by the specific CPT on the order. We check the scheduled procedure against the payer rule, and when authorization is required we tell you before the patient arrives — with the payer, the reference requirement, and the turnaround time you are working against. That gives your staff room to obtain approval or reschedule. Retroactive authorization requests succeed far less often than approvals obtained in advance, which is why the timing matters more than the effort.
Working ahead of the schedule
Verification runs against your appointment calendar, typically a few business days out, so there is time to act on what we find. High-volume plans get checked through batch eligibility transactions; the rest go through payer portals or direct calls when the portal response is incomplete or ambiguous. Same-day add-ons and walk-ins are handled in real time. Results land back in your system as structured notes your registration staff can read at check-in without opening a second application.
Process
How eligibility verification runs with us
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01
Pull the schedule
We take your upcoming appointment list from your practice management system, including add-ons, and sort it by payer so batch-capable plans and portal-only plans are worked through the right channel.
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02
Verify coverage and benefits
Each patient is checked for active coverage on that date of service, plan type, network status, and patient financial responsibility. Ambiguous or partial payer responses get escalated to a live call.
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03
Flag authorization and exclusions
Scheduled procedures are matched against payer authorization rules and plan exclusions. Anything requiring approval is returned to your staff with the payer contact and the deadline attached.
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Update the record
Corrected demographics, current policy details, and patient responsibility amounts are written back into your system before check-in, so registration and collection both work from verified data.
More services
The rest of the revenue cycle
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Medical Coding
Medical Coding
Certified coders assign accurate CPT, ICD-10, and HCPCS codes with NCCI edit checks, E&M leveling, and documentation queries that cut denials and audit risk.
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03
AR Follow-up & Denial Management
AR Follow-up & Denial Management
WNL RCM works aged receivables and denials to root cause: claim triage, payer escalation, documented appeals, and reporting that stops denials from repeating.
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Credentialing & Contracting
Credentialing & Contracting
WNL RCM manages payer enrollment, CAQH and NPI upkeep, re-credentialing deadlines, and contracting so your providers get in network and stay billable.
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Credit Balance Resolution
Credit Balance Resolution
Clear credit balance backlogs with WNL RCM: reconcile true overpayments, correct misapplied postings, process compliant refunds, and document every action.
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FAQ
Eligibility Verification questions
How far in advance do you verify eligibility?
We typically verify a few business days ahead of the appointment, which leaves time to obtain prior authorization or contact the patient about a coverage problem. Same-day add-ons and walk-ins are verified in real time. The exact lead time is set with you during onboarding based on how far out your schedule is built.
Do you verify secondary and tertiary coverage?
Yes. When a patient carries more than one policy we confirm each one and establish the coordination of benefits order, because billing the wrong payer first is a common and entirely avoidable denial. We also flag Medicare Secondary Payer situations so the claim carries the correct occurrence codes from the start.
What happens when a patient has no active coverage?
Your staff is notified before the visit with the termination date and any replacement policy the payer discloses. That gives your front desk the option to contact the patient for updated insurance, collect as self-pay, or reschedule. The alternative is discovering it after the claim denies, weeks later.
Do you work inside our existing software?
Yes. Our team works directly in your practice management system or EHR using credentials you control and permission levels you set. There is no data migration and no new platform for your staff to learn. Verification results appear where your registration team already looks.
Does eligibility verification actually reduce denials?
It removes an entire category of them. Coverage-related rejections — terminated policies, wrong payer, missing authorization, identity mismatches — are preventable at registration and expensive after submission. Catching them before the encounter means the claim never enters your A/R aging in the first place.
Next step
Get eligibility verification off your plate.
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.