Insurance verification
Insurance verified before every visit.
Focus on patients, not processes.
Insurance verification on your schedule.
Faster new-patient insurance intake.
Spend time with patients, not phone calls and portals.
What Silna's insurance verification includes.
We care about better care. Silna automates patient clearance workflows to let teams get out of spreadsheets and get back to caregiving. Our AI-powered platform is backed by high-quality operators with years of healthcare experience.
Make denied claims a thing of the past.
What Silna customers say.
Physical therapy
What a great find Silna was for us! Prior authorizations and insurance verifications were always the bane of my team's existence…
Saul Zion, CEO, Zion Physical Therapy
1 to 2 hrs
Admin time per staff member per day
Insurance verification guides
Frequently asked questions
Insurance verification is the check a provider runs before care to confirm that a patient's coverage is active and what the plan will pay for the scheduled service. It has two layers. Eligibility verification confirms the plan is in force on the date of service. Benefits verification, also called insurance benefit verification, confirms the copay, coinsurance, deductible remaining, visit limits and any prior authorization requirement for that service. Medical insurance verification needs both layers, because a patient can have active coverage that pays little for the care on the schedule.
Silna Health runs both layers for every new patient as part of its Care Readiness Platform. It is built for providers who see patients again and again, including ABA therapy, behavioral health and physical, occupational and speech therapy. Silna checks each patient's coverage, accumulators, authorization requirements and visit limits, so intake is fast and the quote a family receives is accurate.
For the eligibility layer on its own, see insurance eligibility verification. For the step-by-step method your own team can follow, see the insurance verification process.
You verify insurance by checking two things before the visit: that the patient's plan is active on the date of service, and what the plan covers for the scheduled service, including copay, coinsurance, deductible remaining, visit limits and authorization requirements. Staff can do this by phone or through payer portals one patient at a time. Silna runs the same check automatically for every new patient and repeats it on a schedule.
An eligibility check confirms the plan is active on the date of service, using the member ID and date of birth exactly as they appear on the card. Active coverage is only the first layer. To bill correctly you also need the benefits for the scheduled service and any prior authorization requirement.
Yes. Real-time eligibility checks through the standard 270/271 transaction confirm active coverage in seconds, but the benefit details a payer returns vary, so some checks still end with a portal visit or a phone call. Silna automates the whole check, including those calls, and returns the results with an out-of-pocket quote for the family.
Silna's insurance benefit checks end with a record your team can act on. The table shows what Silna checks and why each item matters when a patient is seen every week.
| What Silna checks | What your team sees | Why it matters in ongoing care |
|---|---|---|
| Active coverage | Whether the plan is in force on the date of service | A lapsed plan turns every later session into unbillable care |
| Deductible and out-of-pocket | How much of each has been met this plan year | The family's cost changes as the year goes on |
| Copay and coinsurance | What the patient owes for the service | The intake quote is the number the family plans around |
| Visit limits | Visits allowed and visits used | Sessions past the limit go unpaid |
| Authorization requirements | Whether the service needs prior authorization | Care can't start until the approval is in place |
| Exclusions and limitations | Services the plan won't cover | The team learns this before the first session |
| Out-of-pocket quote | An estimate for the family, built from your rate tables | Families know their cost before care starts |
Once all benefits are verified, Silna notifies the people you choose. When a check shows that a service needs approval, the case moves to prior authorization.
- A new patient enters intake. Silna checks every new patient automatically.
- Silna checks eligibility and benefits with the payer. That covers commercial and government plans, including the payers that still need a phone call.
- Silna builds the family's quote. The out-of-pocket estimate uses your own rate tables.
- Your team gets the results. Silna notifies the people you choose once benefits are verified, and it can update your EHR through Silna's integrations. An operations lead at a multi-location provider said: "I'm impressed by how fast Silna gets an authorization approved, and even more impressed that Silna can update our EHR with exactly what's required to unlock scheduling and billing."
- Silna keeps the answer current. Eligibility is re-checked monthly, and benefits annually or at your request, and insurance monitoring flags lost or new coverage. Services that need approval go to prior authorization.
For the mechanics of automated checks, see automated insurance verification.
Insurance verification decides whether a claim gets paid and whether the patient is billed correctly. Skipping it leads to denied claims, unbillable sessions and surprise balances for families. At Behavior One, one plan switch that went undetected for three months cost the practice over $10,000 in unbillable services, per the Behavior One case study.
A single visit needs one check. Ongoing care needs the same answers to stay true for months, while plans reset, change or lapse between sessions.
ABA therapy
ABA programs deliver many sessions a week, so a coverage change that goes unnoticed repeats with every session. In 2024, ABS Kids estimated about $150,000 in unbillable services tied to coverage changes that went undetected before care was delivered, per the ABS Kids case study. "We're no longer finding out that a child's coverage changed six weeks after the fact. We know before the session happens," said Mellanie Page, EVP of Operations at ABS Kids. More on ABA therapy.
Behavioral and mental health
Behavioral health patients are often seen weekly for months, and a plan switch can happen between any two visits. At Behavior One, a client's change of medical plan went undetected for three months and cost the practice over $10,000 in unbillable services, per the Behavior One case study. Silna detects mid-treatment coverage changes and secondary insurance automatically. More on behavioral health.
Physical, occupational and speech therapy
Therapy benefits often carry a visit limit per plan year, and most plans reset in January, so every patient needs a fresh check at the same time. HealthPRO Heritage completed more than 10,000 benefit checks in under 7 days in January 2026, down from nearly 60 days the year before, per the HealthPRO Heritage case study. At ZionPT, benefits verification and authorization work took about six hours a day across the admin staff before Silna, and now takes one to two hours per staff member per day, per the ZionPT case study.
Because coverage can change between visits, Silna pairs each check with insurance monitoring, which confirms that every patient's plan is still active and flags new plans.
In medical billing, insurance verification is the first step of the revenue cycle. It happens before the visit, ahead of coding, claim submission and payment posting, and it confirms the coverage and benefits that every later step relies on. An error at this step becomes a denial later.
A manual check covers one patient at a time by portal or phone, and the full benefit detail often takes longer than the eligibility response. With Silna, AnswersNow cut its benefit check turnaround from 72 hours to 19 hours, and HealthPRO Heritage completed more than 10,000 benefit checks in under 7 days, per the AnswersNow and HealthPRO Heritage case studies.
AnswersNow improved its benefit check turnaround 3.8x, from 72 hours to 19 hours, and handled double its patient volume while reducing admin headcount by 50%, per the AnswersNow case study.
Silna has processed 7,115 benefit checks and 39,680 eligibility checks for ABS Kids, and ABS Kids generated more than $1 million in annual value from the partnership, per the ABS Kids case study.
HealthPRO Heritage reached 94% eligibility confirmation within the first week of January and delivered more than 2,400 additional care hours, per the HealthPRO Heritage case study.
Customers rate Silna 4.8 out of 5 across 66 verified reviews on G2.
Practices use in-house staff, insurance verification services, eligibility software or a platform like Silna. The right choice depends on how many new patients you see, how often they return, and how many of your payers still need a phone call.
| Approach | What you get back | Re-checks after intake |
|---|---|---|
| In-house staff | Whatever an insurance verification specialist records from payer portals and phone calls | When someone schedules one |
| Outsourced verification service | Benefits on the service's own form, from an external team working your patient list | Per request, unless you arrange a schedule |
| Eligibility software or a clearinghouse | Active status from an electronic 270/271 inquiry, plus whatever benefit detail the payer returns | Per request, often at scheduling |
| Silna | Coverage, accumulators, visit limits, authorization requirements and a family quote, including payers that need a phone call | Eligibility monthly, benefits annually or on request, plus monitoring for lost and new coverage |
In-house staff suits low volume and few payers, and an outsourced service suits overflow or a backlog. If most of your patients come once, eligibility software may be enough. If they return every week, the checks after intake matter as much as the first one, and that is the work Silna is built for. For a feature-by-feature evaluation, see insurance verification software.
Before you choose a partner to verify insurance for your practice, ask these five questions.
- Does it return benefits, or only active status? A family quote needs the copay, the deductible remaining and the visit limits.
- Who calls the payers that don't answer electronically? Some plans still need a phone call.
- Does it re-check after intake and after plan-year resets? Coverage changes between visits.
- Does it flag new or lost coverage? A missed plan switch shows up later as unbillable care.
- Does the result reach your team and your EHR? A check helps only when the right person sees it in time.