---
title: Check insurance eligibility before a visit | Nextvisit
description: Review policy and service details, request payer coverage, and prepare upcoming visits.
url: "https://nextvisit.ai/help/insurance-eligibility"
type: static
generatedAt: "2026-09-21T03:14:00.301Z"
---

Workspace and billing
# Check insurance eligibility before a visit

Review policy and service details, request payer coverage, and prepare upcoming visits.
        Updated September 7, 2026
Use **Insurance > Eligibility** to request coverage for a specific patient, provider, and service date. These steps apply to workspaces with Insurance enabled.

## Before you start

Complete [connection and provider setup](/help/insurance-setup). Your workspace needs an active connection with external writes enabled, a billing provider, and the patient’s policy. Workspace owners, administrators, staff, and editors can check coverage.

Select the intended environment first. Use synthetic patient records with a Claim.MD test account or a Stedi test API key in **Test environment**.

## Request coverage

 1. Select **Check coverage** and choose the patient.
 1. Select the **Insurance policy**. If coverage is missing or incorrect, select **Add or correct policy**, save the policy, then select **Return to coverage check**.
 1. Select the **Clearinghouse connection**, **Rendering provider**, and service location when applicable.
 1. Confirm the **Service date** and **Service type code**. Enter a **Procedure code** when the request needs one.
 1. Select **Check coverage**.

The request appears in the eligibility list. Its request status updates as it is queued and processed. You can leave the page and return to the saved request.

## Read the result

Open the request to review its coverage status, checked time, service, payer reference, and unresolved details.

**AI benefit summary** shows **Estimated visit cost**, **Copay**, **Deductible remaining**, and **Coinsurance** when those values are returned. Expand **View payer sources** on a benefit row. Expand **Full payer response** to inspect the retained response.

| Result | Meaning and next action |
| --- | --- |
| **Succeeded** | The request completed. Read the separate coverage and benefit results. |
| **Unknown** coverage | The response did not establish coverage. Review unresolved details or verify with the payer. |
| **Inactive** coverage | Review the policy and service date before correcting or repeating the request. |
| **Not returned** | The payer did not supply that benefit value. It is not a zero-dollar benefit. |
| **$0.00** | The returned amount is zero. Review its service, network, coverage level, and period. |
| **Legacy unverified** | Obtain a new payer response before using the historical benefits. |

Active coverage does not guarantee payment. Use **Authorizations** to review authorization requirements and prepare an estimate from the applicable benefit evidence.

## Prepare upcoming visits

 1. Open **Overview** and select **Add visit**. The form title is **Add visit to preparation**.
 1. Select the patient, policy, connection, provider, visit date and time, and service details.
 1. Select **Run scheduled eligibility checks before this visit** if you want a scheduled check.
 1. Select **Add visit**.
 1. In **Visits to prepare**, select the visits to check and choose **Check coverage**.

Each selected visit uses its recorded connection, provider, policy, and service. This list contains visits entered by your workspace; it does not import a calendar automatically. **Cancel visit** removes a visit from the preparation list.

## Retry or resolve a request

For a policy-loading error, select **Retry**. For a saved request, correct the displayed issue and use **Recheck coverage**. Use **Refresh** after automatic refreshing pauses. **Cancel queued request** stops a request that is still waiting to run.

If the result is **Outcome unknown**, review the retained request and contact your administrator to reconcile it before sending another request.
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