Why did my claim deny if eligibility came back active?

Active eligibility only confirms the policy is in force. It doesn’t confirm the service is covered, that authorization exists, or that the claim is coded correctly. Most active-but-denied claims fail on one of those points.

Does a 271 response tell me if a specific procedure is covered?

Not reliably. A standard 270/271 exchange confirms member status and general plan data. Many payers return only high-level benefit categories, so a service can be non-covered even when the 271 shows active coverage.

Can coverage be active on the date of service and still get terminated later?

Yes. Retroactive termination happens when a payer or employer ends coverage after the fact. Your check was accurate the day you ran it, but the payer later backdates the effective dates and denies the claim.

How do I know which payer to verify when a patient has more than one plan?

Ask about every plan at intake and confirm the coordination of benefits order. Verifying the secondary plan as if it were primary is a common cause of active-but-denied claims. Check primary, secondary, and any Medicaid managed care assignment.

Is prior authorization checked during eligibility verification?

No. Prior auth is a separate step tied to the specific procedure and diagnosis. A claim can show active coverage and still deny for no authorization on file, so the auth check belongs in scheduling.

What does an active-but-denied claim actually cost us?

Reworking a single denial costs an estimated $25 to $118 in staff time, and about 60% of denials are never reworked at all. Preventing the denial up front is far cheaper than chasing it after the fact.

How can a billing partner reduce active-but-denied claims?

A strong partner verifies benefits at the service level, confirms COB order, flags auth requirements before the visit, and reworks denials fast. Qualigenix runs these checks across 38+ specialties with a 95% first-pass acceptance rate.

Real-time eligibility returned active and the claim still denied: the five reasons why

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