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Manta Health's Eligibility and Coverage Verification gives specialty practices real-time benefit intelligence at the point of scheduling, not at the point of billing. Learn more about Coverage Intelligence →
Eligibility and coverage verification is the process of confirming a patient's active insurance coverage, benefit details, and prior authorization requirements before care is delivered. In most practices today this is a manual process: a staff member logs into a payer portal, requests a benefits summary, and interprets the result by hand. Manta automates and interprets this process, returning a treatment-aware benefit summary directly in the workflow where staff already operate.
A single eligibility check at scheduling is not enough. Coverage details change. Plans lapse. Deductibles reset. A check run six weeks before a procedure may not reflect the patient's actual coverage on the date of service.
Manta re-runs eligibility automatically as treatments move through the workflow: at treatment creation, at key workflow transitions, and at the start of each service month. Coverage data driving authorization decisions, patient estimates, and pre-payment collection stays current, not stale from the day the appointment was booked.
Staff can manually re-run an eligibility check from the treatment or patient view at any time.
Eligibility and coverage verification is the first step in the Coverage Intelligence workflow. Accurate benefit data at the point of scheduling is what makes everything downstream possible: prior authorization decisions are based on verified payer requirements, patient estimates are calculated from real benefit data, and pre-payment collection is grounded in what the patient actually owes.
Eligibility determines whether authorization is required. Manta prepares and submits documentation automatically for any payer.
Every denial auto-appealed immediately upon receipt. Payer-specific AI drives a 90%+ overturn rate.
Verified benefit data feeds directly into patient cost estimates and pre-payment collection before treatment.
Eligibility verification is the process of confirming a patient's active insurance coverage and benefits before care is delivered. It includes validating plan enrollment, confirming coverage for specific services, and identifying requirements such as prior authorization or patient cost-sharing responsibilities.
A 271 is the standard electronic response to an eligibility inquiry in healthcare. It contains structured benefit data including coverage status, deductible amounts, copays, coinsurance rates, and out-of-pocket maximums across multiple service types. Raw 271 data requires interpretation to be actionable. Manta's AI layer interprets it against the planned treatment and produces a plain-English benefit summary.
Manta submits real-time eligibility requests through clearinghouse connections to providers like Stedi and pVerify, then interprets the structured benefit response against the specific CPT code and treatment planned for the patient. The result is a plain-English summary of coverage, cost-sharing, and authorization requirements.
Manta connects to payers through Stedi for medical eligibility and pVerify for vision plans including VSP and EyeMed. Payer routing is handled automatically based on the insurance company on file.
Manta runs eligibility automatically when a treatment is created and re-runs it as the treatment moves through the workflow. Eligibility is also re-verified at the start of each service month so that coverage data is current at the time of service. Staff can manually re-run a check at any time.
Manta's insurance discovery capability uses patient demographics to identify active coverage across national and regional payers. Where coverage is found, the carrier, plan, member ID, and group ID are returned so the eligibility workflow can proceed normally.
The eligibility check identifies whether prior authorization is required for the planned CPT code under the patient's payer. That determination feeds directly into Manta's prior authorization workflow, so the authorization process begins with accurate payer requirements already confirmed.
Say goodbye to faxes, lengthy phone calls, and tedious RCM admin.
