Eligibility & coding
Real-time eligibility
Know what's covered before anyone writes a claim. Run 270/271 eligibility inquiries through the clearinghouse connection and get coverage back in a readable layout. Results are saved to the patient so the claim builder can use them. Eligibility is often checked late, or by someone at the front desk on a payer website, with the answer written on a sticky note. What ships here includes 270/271 inquiries via clearinghouse; readable coverage summaries. Used day to day by biller, supervisor roles, with availability marked available. Open the sample screen on the right, then walk the steps below — or book a demo and put your hand on the same flow with synthetic data.
Eligibility · 270/271
- Plan statusActive
- Specialist copay$40
- Deductible remaining$310 of $1,500
What it is
Run 270/271 eligibility inquiries through the clearinghouse connection and get coverage back in a readable layout. Results are saved to the patient so the claim builder can use them.
The problem it solves
Eligibility is often checked late, or by someone at the front desk on a payer website, with the answer written on a sticky note. Many avoidable denials start right there.
Process
How it works, step by step
- 1
Choose patient and payer
Start from the patient's coverage on file, or enter new details.
- 2
Send the inquiry
MEDBIX sends a 270 request through the clearinghouse and waits for the 271 response.
- 3
Read it like a person
Active status, plan details and benefit information are laid out clearly instead of as raw codes.
- 4
Carry it forward
The verified coverage flows into the next claim for that patient.
What's included
Everything below is part of real-time eligibility today.
- 270/271 inquiries via clearinghouse
- Readable coverage summaries
- Coverage saved to the patient record
- Feeds directly into claim building
- Batch-friendly for busy days
- Every request kept in transaction history
The guardrail
Eligibility answers come from the payer response. AI can help interpret them, but doesn't invent coverage.
Where it fits: the full rcm loop
This is the whole job of a billing company, end to end. Every step lives in MEDBIX, so nothing falls into the gap between two tools.
- MEDBIX
- Clearinghouse / payer
- Person decides
- 1
Patient & insurance on file
MEDBIXDemographics and coverage, from import, EHR ingest or entry.
- 2
Eligibility (270/271)
Clearinghouse / payerCoverage confirmed through the clearinghouse before billing.
- 3
Charge capture → claim draft
Person decidesEncounter becomes a draft claim in the builder.
- 4
Deterministic scrub
MEDBIXRules run; AI can explain any finding.
- 5
Human review & approve
Person decidesRequired before anything leaves.
Audience
Who uses it
These roles work with this feature day to day. Access always follows what your admin assigns.
Works closely with
More in Eligibility & coding
Deep dive
What Eligibility Checks means in daily ops.
Practical context for Eligibility Checks: how teams use it, where it sits in the loop, and what to ask in a demo.
- Tied to how billing work actually splits
- Clear on human vs machine responsibility
- Links into related MEDBIX areas
Practice
Where this shows up on a busy day.
From morning eligibility checks to end-of-day posting, Eligibility Checks connects to the queues your team already lives in.
- Morning coverage and claim build
- Midday scrub and approval
- Afternoon denials and patient pay
Control
Keep a person on the send button.
Whatever page you're on, MEDBIX keeps AI in a propose role. Approvals, posting and rule activation stay human.
- Named approvals
- Visible AI proposals
- Immutable audit trail
Next
See Eligibility Checks against your volume
Bring your payer mix and the friction you feel today. We'll map it onto sample data in thirty minutes.
- Sample data only
- Your questions drive the agenda
- Written follow-up after
Common questions
Which clearinghouse do you use?
Stedi, a modern JSON clearinghouse API, for eligibility, claims and remittance.
Is eligibility live in production?
Eligibility can run on the live production path. We'll confirm the current state for your payers during onboarding.
Can front-desk staff use it?
Anyone with the right role in your company account can run checks.
Want to walk MEDBIX against your real claim mix?
Thirty minutes with sample data. We'll follow one claim through the gate, then talk about your payers, practices and where the rework hurts today.
Notes from the billing floor
Occasional, practical writing on denials, A/R and running a billing company. No spam, unsubscribe any time.