AI-Powered Eligibility & Benefit Verification
Know what's covered before the patient walks in.
BlackBook 2026 #1 : AI-Powered Claims Automation (9.67/10)
96%
Verified with no human touch
31%
Fewer eligibility denials in 90 days
11%
Of patients carry coverage your EHR is missing
AI that verifies every patient end to end from overnight coverage checks to hidden-plan discovery to coordination of benefits to a patient estimate that holds. Clean verifications never reach your team.
The Front-End Crisis
Denials are decided before the visit. Your front desk finds out after the claim.
The information that decides whether a claim gets paid is available days before the patient arrives: the right payer, the right order, the service-type coverage, the deductible that remains. What's missing is the time to check every patient, the data to see coverage the EHR never captured, and the expertise to read a 271 that says active and still means denied.
1/4
of denials originate before the visit, in eligibility and registration. Lost at the front desk, not in coding.
9/10
of those were visible in the payer's response before the visit. Not unforeseeable. Just unread.
How RapidEligibility works
Verify. Discover. Resolve. Estimate. Prevent.
Verify & Refresh
Every patient checked before the visit. Every answer sourced.
Every scheduled patient runs through an overnight 270/271 batch and returns a coverage status, confidence score and rationale in the payer's own segments. Cadence is set per line of business: marketplace weekly, commercial nightly, Medicare on its own clock. No stale verification presented as current.
98% coverage confidence · Cadence per line of business
Discover & Reconcile
Every plan found. Including the ones nobody entered.
Discovery returns coverage the EHR never captured: a spouse's employer plan, a missed secondary, a marketplace policy in a grace period. Each plan comes back with member ID, group and live accumulators, reconciled against the chart and flagged to registration where they disagree.
11% hidden-coverage hit rate · Reconciled against the EHR record
Resolve COB & Order
Every payer in the right position. Every rule shown.
Coordination of benefits is resolved, not reported. The correct order is computed beside the EHR's current order, with the deciding rules named: employer over marketplace, MSP against the Common Working File, ESRD windows, hospice. The corrected order writes back to eCW or Epic.
MSP + CWF + ESRD 30-month · Writeback to eCW and Epic
Estimate & Write Back
Every patient told the real number. Before the visit.
The estimate is built from the contracted rate and live 271 accumulators, not the charge master. Where pending claims elsewhere could consume the deductible, accumulator drift is flagged. Estimate, coverage and COB order all push back to the EHR, so registration and billing share one answer.
Priced on contracted rate · Accumulator drift flagged
Prevent & Compound
Nothing leaves the queue until the payer agrees it's fixed.
Resolved exceptions re-verify before they close, and every one teaches the system which plans need a tighter cadence and which lines are delegated. That intelligence flows to Rapid Prior Auth and RapidRecovery. The front end stops being where denials are born.
Resolved → re-verified → protected · Integrated with Rapid Prior Auth + RapidRecovery
Results
What our customers recover.
96%
Of verifications clear with no human touch Large Health System · 1.1M verifications/year
$1.9M
Patient responsibility collected before the visit Multi-Specialty Group · 210K visits/year
31%
Fewer eligibility denials in the first 90 days FQHC Network
Why RapidEligibility
Not another eligibility check. A complete patient access engine.
Your team sees thirteen problems. Not eleven thousand verifications.
Exceptions-Only Verification
Every other tool hands back a verification per patient, so someone still reads all of them. Here clean verifications never surface. The queue holds one row per problem, ranked by expected value, and resolved rows re-verify before they close.
One row per problem · Resolved re-verifies before closing
Six minutes in the NIA queue. Zero of them yours.
AI Payer Calls That Sit on Hold
Some answers only exist on a phone line. The voice agent places the call, navigates the IVR, enters the provider tax ID, waits in the queue and archives a timestamped transcript, pulling a human in only when a decision is needed.
3 IVR levels navigated · 0 human minutes on hold
Plan-level "active" is how a verified patient still gets denied.
Service-Type-Level Benefits
Most checks stop at the plan. Coverage here is parsed per service-type code against this visit's CPTs, with copay, coinsurance and network status attached. Where the payer returns nothing, the field says unknown instead of inheriting the plan-level answer.
Per-STC coverage · Unknowns named, not inherited
Your EHR says Ambetter. The rules say Cigna. We settle it.
Coordination-of-Benefits Resolution
Most tools report both plans and leave the order to the front desk. Here the order is computed from the governing rules, the disagreement with the EHR is shown, and the correction playbook is sequenced across agent and human work.
MSP · ESRD 30-month · Marketplace grace · Hospice
Purpose-Built
Built for your organization
FQHCstrust RapidClaims
FQHCs
Sliding-fee determination and Medicaid MCO status confirmed before the visit, not at checkout. Capture the coverage patients didn't know they had.
Community Health Centers
Medicaid redetermination churn and marketplace grace periods tracked plan by plan. Fewer self-pay write-offs on patients who were actually covered.
Accountable Care Orgs
Attribution and coverage confirmed against total-cost-of-care panels. One verification layer, no per-site build.
Physician Groups
Referral and authorization requirements surfaced at scheduling. Collect patient responsibility before the visit.
Hospitals and Health Systems
COB, MSP and ESRD coordination resolved to the Common Working File. Protect high-dollar revenue at the front end.
Don't see your org type?
Get in touch with our team
If you verify patients at scale, RapidEligibility can help. Tell us how your team works.
Talk to us
Verify it upfront. Never fight it later.
RapidEligibility works alongside RapidPriorAuth™ and RapidRecovery™. Authorizations open knowing which payer governs them, and post-service denials arrive with the eligibility evidence attached.
BlackBook 2026 #1 : AI-Powered Claims Automation (9.7/10)
Frost & Sullivan 2025 : Technology Innovation Leader
BlackBook 2025 #1 : AI-Powered Claims Automation (9.61/10)
Works with your existing systems.
RapidEligibility integrates with your EHR and billing system over X12 270/271, payer portals, HETS and voice. No rip-and-replace. No workflow disruption.
