Patient access
Eligibility, Benefits & Financial Clearance
Coverage, service-level benefits, and pre-service financial-clearance status, verified through approved payer channels and documented within the practice’s workflow.
Overview
Financial clearance is the work of establishing, before a service is delivered, that the patient is covered, that the service is a covered benefit, that any referral or authorization requirement has been identified, and that the patient’s expected responsibility has been estimated from the information the payer makes available. Done well, it reduces the eligibility, referral, and authorization denials that are otherwise discovered only after the claim is filed. How far ahead of a service the status can be completed depends on the payer’s own process.
Ellery Health Partners verifies active coverage and effective and termination dates, identifies the plan and product, resolves primary and secondary coverage and coordination of benefits, confirms network status, and records service-level benefits including deductible, copay, coinsurance, out-of-pocket maximum, and accumulators where the payer provides them. Coverage limitations, exclusions, and visit, unit, and frequency limits are noted, referral and authorization requirements are flagged, and a patient-responsibility estimate and financial-clearance status are documented in the practice’s system. Where portal data is insufficient, verification is completed by telephone.
What Ellery Health Partners handles
- Active coverage, effective dates, and termination dates
- Plan and product identification across commercial, Medicare, Medicare Advantage, Medicaid, and managed-care coverage
- Primary and secondary coverage and coordination-of-benefits identification
- Network status and service-level benefits, including deductible and remaining deductible, copay, coinsurance, out-of-pocket maximum, and accumulators where available
- Coverage limitations, exclusions, and visit, unit, and frequency limits
- Referral and authorization requirement checks
- Payer telephone verification when portal data is insufficient
- Patient-responsibility estimates from available payer and plan information
- Insurance-information discrepancy resolution where appropriate and available; insurance discovery is scoped separately
- Pre-service financial-clearance status
Where it sits in payer administration
Eligibility and benefits work feeds directly into referral management and prior authorization, and a documented financial-clearance status is what claims and denial work refers back to when a payer disputes coverage.
Within your existing systems
Ellery Health Partners performs this work inside the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and the payer telephone channels the work requires.
Your practice provisions the accounts, sets the permissions, and can modify or revoke access at any time. Nothing is moved into a separate Ellery Health Partners patient database.
Reporting and accountability
Ellery documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate. That tracking is aggregate and contains no protected health information; patient-level case detail stays in your systems.
Reporting appropriate to the engagement covers case status, last payer action, next follow-up, deadlines, determinations, unresolved issues and escalations, and the administrative barriers that recur.
Service boundaries
What verification can and cannot establish:
- Verification reflects the information the payer makes available at the time of inquiry
- Patient-responsibility estimates are estimates from that information, not a guarantee of coverage or payment
- Patient financial counseling and collection of balances remain with the practice
- Final coverage and payment decisions are made by the payer
When work is scoped separately
Routine verifications are included in the Eligibility & Benefits Desk and the Payer Desk plans. Scoped separately:
- Insurance discovery for patients presenting without usable coverage information
- High-cost service estimates that require multiple payer contacts
- Pre-surgical or pre-infusion financial-clearance programs run on a schedule
- Volume above the published plan tiers
Specialties where this work is concentrated
Get started with Ellery Health Partners
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.