Run a real-time eligibility and benefits check for one patient against one payer, on a clearinghouse-style portal such as Availity Essentials or a regional health plan’s own portal. Coverage status back in minutes, with the benefit detail a 271 response usually doesn’t carry.
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Overview
A browser agent runs the check your front desk or verification team runs today: it signs in to the portal, selects the payer and your provider NPI, identifies the member, and submits an eligibility and benefits inquiry for the service type and date you specify. The same workflow shape covers the clearinghouse-style portals that aggregate the largest payers and the regional health-plan portals no clearinghouse reaches.
You identify the patient by member ID, or by name and date of birth when the ID isn’t on file. Service type and as-of date are optional; the form’s defaults and today’s date apply when they’re empty.
How Asteroid runs this workflow
Patient, payer, and service details arrive from intake, Asteroid runs the portal inquiry and reads the payer's full response into one structured record back to your queue, and an incomplete or conflicting payer answer routes to staff with the source evidence instead of being smoothed over.
How it actually runs
Anything the payer doesn’t show comes back null. The agent never fills a gap with a guess, because a wrong copay quoted to a patient is worse than a blank one.
Patient, payer, member, service, and date-of-service details are ready
Structured record back to intake
Coverage status with normalized deductible, copay, coinsurance, benefit limits, and prior-auth and referral flags lands back in your intake queue, feeding the prior-auth work downstream.
Incomplete or conflicting payer response: A member not found, an unreachable payer, or a response that doesn't add up routes to staff with the portal's exact wording; a person rules on it once.
Closing the loop
Nobody on your team reads this JSON. Your system does. Each run delivers its record wherever the work already lives, and the loop closes on its own: requests in, records back, no one in the middle.
{ "status": "active", "payer_name": "EXAMPLE HEALTH PLAN", "member_id": "W••••••04", "plan_name": "PPO Choice", "coverage_start": "2026-01-01", "coverage_end": null, "copay": "$30 specialist / $15 PCP", "deductible_individual": "$1,500.00", "deductible_remaining": "$412.50", "out_of_pocket_max": "$6,850.00", "prior_auth_required": true, "referral_required": false, "messages": [ "Benefits verified as of 07/16/2026" ]}The standard eligibility transaction answers one question: is the plan active. What your team actually needs before the visit is the rest: what the copay is, how much deductible is left, whether the out-of-pocket max is met, and whether the service needs prior authorization or a referral. That detail frequently exists only on the portal screen, which is why teams still log in by hand after the clearinghouse feed already said “active.” This workflow captures that on-screen detail as structured data, including the prior-auth flag that feeds the prior authorization workflow library one step downstream.
At scale
A single run answers one patient-payer question. At schedule scale, runs execute in batch overnight against tomorrow’s appointment list, and your team arrives to a completed verification queue with exceptions flagged. Every check skipped for capacity reasons is a coin flip on a downstream denial.
Verification is part of the eligibility and benefits workflow library. For the operational economics, see the medical billing automation deep-dive.
Human in the loop
The workflow is strictly read-only: it never touches authorizations, claims, or account settings. Every run is logged with a full audit trail on HIPAA-compliant infrastructure; see our security page for the audit and access-control posture.
Member not found or ID invalid.
Reported as a clean not_found result with what was searched, never a near-match under the wrong member.
The payer can’t be reached through the portal.
The run fails with the exact message shown, so a stale answer is never recorded as a fresh check.
An unexpected portal state.
A password-expiry prompt, a terms update, a survey modal: the agent reports it rather than clicking through.
Questions
Verification is one workflow in the eligibility and benefits workflow library. Every check skipped for capacity reasons is a coin flip on a downstream denial. The check costs minutes; the denial costs the claim.
Disclaimer
Third-party names, including government agencies and registries, are used only to identify systems commonly involved in healthcare operations workflows. Asteroid is not affiliated with, endorsed by, sponsored by, or certified by those third parties unless expressly stated. Workflow availability depends on customer authorization, account permissions, configuration, and applicable system terms.