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Insurance eligibility check

Real-time 270/271 verification with copay and deductible surfacing.

FILE № EL-271-2026
Eligibility Ledger
X12 270/271 verification register · realtime aggregator
FOLIO 2026-07-17
PAGE 01 / 01
CHECKS / D
3,412
270 SUBMITTED
ACTIVE
89.1%
+0.4 PP
RESPONSE / AVG
1.4 s
P95 · 2.8 s
TERMINATED
6.2%
→ SELF-PAY
§ II — DETERMINATION

Lila Hamasaki

ACTIVE
PPO Bronze 6000 · IN-NETWORK · EFF 2026-01-01 · COB PRIMARY
COST SHARES
PCP COPAY$25
SPECIALIST$80
URGENT CARE$50
EMERGENCY ROOM$500
COINSURANCE20%
ACCUMULATORS · YTD
DEDUCTIBLE / IND$862 / $1,500
OOP MAX / IND$1,708 / $3,750
§ III — PRIOR AUTHORIZATION SCHEDULE
Office visit (99213/14)NOT REQ—
MRI (any region)REQUIREDSubmit clinical w/ failed conservative tx
PT/OTREQUIRED>10 visits requires extension
Outpatient surgeryREQUIRED—
§ IV — DAILY REGISTER
SYNTHETIC · NO PHI
TIMEPATIENTPAYERRESULTLATENCY
09:14:22Hamasaki, L.BCBS ILACTIVE01.42s
09:11:08Nakagawa, P.BCBS ILACTIVE01.18s
08:58:44Reyes, M.AETNAACTIVE / COB01.81s
08:42:31Tanabe, Y.UHCTERMINATED01.07s
08:30:15Marquardt, T.MEDCRACTIVE00.94s
08:21:02Beaumont, S.CIGNAACTIVE01.62s

Front-office · Eligibility

270/271 verification health

Real-time eligibility checks across all payers — what failed and what cost.

Synthetic data

By payer (top 5)

Aetna821
BCBS706
UHC598
Cigna412
Medicare388

Top failure reasons

271 reject codes

  • 72 Subscriber/insured not found
    81
  • 75 Subscriber/insured not in group
    44
  • 41 Invalid/missing date(s) of service
    22
  • 43 Invalid/missing patient ID
    18

Copay & deductible surfaced

Avg patient responsibility flagged at intake

Avg copay
$42
Deductible left
$1,180
Time-of-service collection up +22% since rollout.

Connectors used

Eligibility & Claims

required

Stedi / Availity

Real-time 270/271 verification

Stripe

optional

Charge estimated patient responsibility

Health Records

optional

Redox / Particle Health

Attach coverage to the patient chart