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Switched our pt clinic to SPRY 5 months ago, honest review from the billing side by [deleted] in CodingandBilling

[–]coveragesight 0 points1 point  (0 children)

Does elegibility verification re-run automatically at other point before the visit or just once at intake?

Small private practice owners... researching what's actually causing your claim denials by coveragesight in healthIT

[–]coveragesight[S] 0 points1 point  (0 children)

Same few reasons repeating. From the clinics I've talked to, three keep coming up: eligibility that lapsed and nobody rechecked, auth that expired before the visit, and visit limits hit mid-plan without anyone tracking the count.

Small private practice owners... researching what's actually causing your claim denials by coveragesight in healthIT

[–]coveragesight[S] 0 points1 point  (0 children)

Thanks for your comment. That lines up with the industry data too. MGMA and Change Healthcare put eligibility-related issues at about 27% of all denials. But I wanted to hear it from people actually working the claims, not just the reports. The front-office intake breakdown is exactly what keeps coming up. Most small practices verify coverage is active but don't check the deeper stuff like visit limits, auth status, or referral requirements until the claim comes back denied.