Benefit verification can be one of the most error-prone steps in the patient intake process, and one of the most expensive to get wrong. Entering incorrect copay, deductible, or visit limit information leads to claim denials, delayed payments, and awkward conversations with patients who were quoted the wrong amount.StrataEMR addresses this at two levels. For Medicare patients, benefit verification happens automatically - Mako pulls current coverage details and benefit usage the moment a Medicare policy is saved, with no manual entry required. For all other payer types, StrataEMR provides a structured workflow with a dedicated task system to make sure nothing gets skipped.
Access: All staff can view and enter benefit information.
Medicare benefit verification is fully automated. When a Medicare policy is saved, StrataEMR pulls the patient’s current benefit usage and coverage details directly — including remaining annual cap and copay information. No manual entry is required. The Medicare tracker updates automatically throughout the year as the benefit is used.
Commercial Payers
All other payer types — commercial insurance, Medicaid, workers comp, and others — require manual verification. Your team calls the insurance carrier, obtains the benefit details, and enters them into the Benefits screen. StrataEMR’s task system keeps this process organized and accountable so nothing slips through.
From the patient’s Policies page, click the Benefits button on the relevant policy to open the benefit verification screen. Enter the details obtained from the insurance:
Copay — Fixed dollar amount per visit, if applicable
Co-insurance — Patient’s percentage responsibility, if applicable
Deductible — Annual deductible amount and how much has been met
Out-of-Pocket Maximum — Annual cap and amount already met
Visit Limit — Total visits allowed and how many have been used
Authorization Required — Yes or No, and from which visit authorization becomes required
PCP Referral Required — Yes or No, and whether it has been obtained
In/Out of Network — Confirm the provider’s participation status with this plan
After saving, StrataEMR automatically calculates the recommended collection amount per visit based on the copay, coinsurance, or deductible status entered. This value drives collection tasks for each appointment.
When adding a new policy, you can opt to create a Benefit Verification Required task by checking the Create Benefit Verification Task checkbox next to the Save Policy button. This places a task on the dashboard under Billing Tasks, alerting your team that benefits still need to be obtained for the new policy.This task workflow is optional, but StrataPT recommends using it any time benefits are not verified at the moment a policy is entered. It gives your team a structured, trackable reminder rather than relying on memory or manual follow-up.
Once StrataEMR completes a Medicare benefit verification on your behalf, a Benefit Verification Completed task appears on the dashboard. These tasks do not clear automatically — a staff member must review the entered benefits and mark the task complete manually. Keeping these cleared maintains a clean, accurate task list.
Pending benefit verification blocks documentation. If a Pending Benefit Verification task is active on a patient’s account, StrataEMR will not allow a document to be marked Complete until benefits have been verified and active coverage is confirmed. Verifying benefits before the first visit prevents unnecessary claim denials and payment delays.
