1. Patient Demographics Review
✔ Confirm patient’s full name, date of birth, and contact details
✔ Validate insurance card details against ID
✔ Update any changes before processing
2. Coverage Confirmation
✔ Verify active coverage dates and plan type
✔ Check policy number, group number, and payer ID
✔ Identify if patient is primary, secondary, or tertiary insured
3. Benefit & Eligibility Checks
✔ Confirm deductible, copay, and coinsurance amounts
✔ Check for service-specific limits or exclusions
✔ Review if prior authorization is required
4. Network & Referral Requirements
✔ Confirm provider is in-network
✔ Identify need for PCP referral
✔ Document any special coverage instructions
5. Common Challenges & Fixes
| Challenge | Fix |
| Outdated insurance on file | Ask patients to present card at each visit |
| Inaccurate eligibility details | Verify directly through payer portals or clearinghouse |
| Missing referral requirements | Set alerts in EMR for referral-needed plans |
| Conflicting coverage information | Contact payer rep directly and log all details |
