Most claim denials are archaeology: something went wrong weeks ago, and now your biller is excavating. But one entire category of denial is different, because it's knowable before the session ever happens, coverage. The client's plan lapsed, the family switched insurance at open enrollment, the deductible reset, the plan requires an authorization you don't have. Every one of these is visible in advance, if you look.
Looking has a name: the 270/271 transaction. Your system sends a 270 eligibility inquiry to the payer; the payer answers with a 271 that says whether the plan is active and what it covers, copay, coinsurance, remaining deductible, and whether prior authorization is required. It's the same check a hospital front desk runs when you hand over your insurance card.
It's rarely the intake, most practices verify coverage once, at the start of services. The damage comes from what changes afterward. Families change plans in January and forget to tell you. Medicaid recertifications lapse. A parent's employer switches carriers mid-year. Meanwhile you're delivering twenty hours a week of services against coverage that quietly stopped existing, and you find out when a month of claims comes back denied at once.
The fix is cadence, not heroics: verify at intake, re-verify monthly for active clients (or at minimum quarterly for stable commercial plans and monthly for Medicaid), and re-verify immediately after every January 1st. In ABAVault™ this is built into the workflow, a "Verify benefits" action on the client's insurance record, results stored with history, and a stale-eligibility warning that appears right on the scheduling screen when a session is booked against coverage that hasn't been checked recently.
A useful 271 response tells you four things you should act on. Plan active or not, if not, stop and call the family before the next session, not after. Copay and coinsurance, this sets the patient-responsibility expectation early, which is a kindness to families and a receivables strategy for you. Deductible remaining, early in the year, families may owe the full allowed amount for weeks of services; nobody enjoys that conversation, but everyone prefers it in advance. And auth-required flags, the difference between a covered service and a written-off one.
One honest caveat: eligibility is a snapshot, not a guarantee of payment. Payers say so themselves. But "not a guarantee" is a poor argument against checking, it's an argument for checking often, keeping the raw responses on file, and pairing eligibility with solid authorization tracking so units delivered never outrun units approved. Both run in the same place: see how billing handles eligibility and authorizations.
Practices that run this cadence see the payoff in their denial mix: coverage-related denials, often a meaningful slice of total denials, drop toward zero, which means your biller's time concentrates on the denials that actually require skill. Cash arrives faster because clean claims pay on first pass. And your front office stops being surprised, which is worth more than the money.