VitalEDI Eligibility and Benefit Verification

Eligibility Verification Software


Are You Still Using a Manual Process?

Accelerate the patient eligibility/benefit verification process by utilizing our real-time eligibility tool. Our software will create and submit an electronic benefit inquiry (ASC X12N 270) and within seconds, retrieve the benefit response (ASC X12N 271) from the payer. This process eliminates time-consuming verifications via phone and/or individual payer websites. This allows for additional patient access time, reduced claim denials and increased cash flow in the form of patient co pay/coinsurance up-front payments.

Combine the eligibility tool with our Patient Responsibility Estimator to create accurate estimates to inform your patients, before service, of out of pocket expenses for which they will be responsible. The estimator uses the information returned on the 271 benefit response as input to calculate the patient responsibility amount and to create a customizable, professional estimate to present to your patient.


The VitalEDI Eligibility Verification System provides real-time and/or batch driven processing that results in easy to read responses to eligibility verification requests. Requests can be made for virtually all payers, including Medicare, Medicaid and most commercial health plans. VitalEDI's Eligibility Verification System is perfect for large, networked providers such as Hospitals, Multi-physician practices, Community/Public health facilities, Medical groups, Billing services, and behavioral health networks as it provides you the ability to perform:



Use our eligibility system for:

  1. Insurance eligibility inquiries
    • Date of Service
    • Individual/family deductible (including met amounts)
    • Application of deductible to service
    • Inclusion of deductible in maximum out of pocket
    • Individual/family maximum out of pocket (including met amounts)
    • Co-payments and/or co-insurance
    • Authorization requirements
  2. Patient Identity/Address verifications
  3. Patient's payment responsibility

The VitalEDI Eligibility Verification System also has an enhanced import/export functionality that allows it to receive or output files for your HIS system. These files are customized based on your specifications to ensure compatibility across platforms. In addition, our prices per transaction are one of the lowest in the industry, please contact our sales team to discuss how your facility can benefit by implementing the VitalEDI Eligibility Verfication System.

To learn more about VitalEDI Eligibility Verification System, please Click Here to download our product sheet.



Once you have validated patient information, why not use it to the fullest possible extent? When our Eligibility Verification System is used in conjunction with our Patient Responsibility Estimation tool, the effect is a powerful and dynamic front end system capable of providing your potential patients an estimate with the highest degree of accuracy.

Information can easily be transfered directly from the Eligibility Verification System into the Patient Responsibility Estimation system, allowing for increased processing speed without sacrificing accuracy. Learn more…