01
Preventive and diagnostic are not interchangeable
A screening visit or preventive service can have a different benefit classification from a diagnostic visit, even when the patient sees the same clinician. Insurance coverage depends on the plan, service performed, reason for the visit, provider status and actual coding. A preventive benefit does not automatically make every test or procedure free. Basic Eligibility reports general available benefits and network status. Full Benefits adds more specific online research using the CPT codes the practice sends.
02
Check network status for the right provider
A plan may treat the OB/GYN, imaging site, hospital outpatient department and laboratory as separate entities for benefits. Network status can also differ by location or billing provider. Our verification documents the information available for the intended provider and plan. In network benefits are included with every verification. Out of network benefit information is included when the clinic selects Yes in onboarding, with no separate OON charge.
03
Research office procedures and ultrasound
An OB/GYN visit can include evaluation and management, ultrasound, diagnostic testing or other in-office services. These items may have different benefit rules. With Full Benefits, the practice supplies the applicable CPT or HCPCS codes, and we research relevant online plan information where available. The report notes limitations rather than presenting a procedure as guaranteed covered. Clinical coding decisions remain with the treating practice, and laboratory or facility components may require their own review.
04
Understand prenatal and maternity benefits
Prenatal care, delivery, hospital facility charges, professional fees and postpartum services are not always covered under one simple benefit line. Plans may distinguish global maternity services, specialist care, testing or facilities. Full Benefits may document the available maternity and prenatal benefit information requested by the clinic. This research cannot predict the final cost of a delivery, claim processing outcome or whether every associated provider is in network.
05
Authorization and referral questions
Some plans require referrals, prior authorization for selected procedures or additional review based on site of service. Full Benefits includes online research into the authorization and referral rules attached to submitted codes when the payer makes them available. Authorization research is not authorization approval. If the practice needs help with an actual submission or follow-up, Prior Authorization Assistance is handled by separate custom quote and written scope.
06
Document missing or conflicting payer data
A payer portal may show an active policy but not the exact benefit line for a requested service. A clinic may also have incomplete subscriber information or multiple active plans. In those situations, we document the source and what remains uncertain. We do not infer that a service is covered at no cost simply because it appears preventive, or that an out of network provider has a particular patient responsibility. The practice can review outstanding issues before proceeding.
07
Choose a workflow that fits your front desk
During business-only onboarding, tell us which providers, clinics and service categories you need supported. Select Basic Eligibility for a coverage overview or Full Benefits for requested procedure research. A verification is generally targeted within 24 to 48 hours once we have everything we need and approved access is in place. Before accepting real patient requests, VerifyCallie signs a BAA, completes clinic agreements and confirms appropriate HIPAA safeguards and authorized secure portal access.