How We Handle Eligibility Verification So You Don’t Lose Reimbursement

In Spravato billing, a single missed eligibility check can lead to thousands of dollars in lost revenue—and even worse, treatment disruptions for patients who need consistent care. As a leading Spravato Billing Company, Finnastra ensures every patient is verified, every payer is confirmed, and every treatment is authorized before it ever reaches the claims stage.

Why Eligibility Verification Is Non-Negotiable for Spravato Practices

Spravato (esketamine) is not a routine service—it’s a REMS-regulated, buy-and-bill treatment that demands precision from the start. Each patient’s benefits, coverage limits, and authorization requirements vary by payer. Yet many clinics rely on manual or inconsistent eligibility processes, leading to preventable denials and cash flow gaps.

According to MGMA, up to 75% of claim denials stem from front-end issues—mostly from incomplete or outdated eligibility checks. And in Spravato billing, where the medication alone can cost over $800 per dose, even a single denial can significantly impact profitability.

How Finnastra Prevents Denials from the Start

At Finnastra, we take ownership of your front-end revenue cycle so your team doesn’t have to chase down payers or fight preventable denials. Our Spravato Billing Company is designed to simplify eligibility and benefits verification using a structured, multi-step process:

1. Automated Eligibility Checks – We verify each patient’s insurance coverage in real-time before every scheduled Spravato session. This ensures no lapse in coverage or change in payer policy goes unnoticed.
2. Benefit-Level Verification – Beyond active coverage, we confirm Spravato-specific benefits—deductibles, coinsurance, prior auth requirements, and treatment limitations—to protect your revenue integrity.
3. Preauthorization and REMS Compliance – We initiate and track prior authorizations, ensuring all payer documentation is complete and compliant with REMS and medical necessity standards.
4. Communication and Documentation – Our team provides complete benefit breakdowns to your staff, making it easy for clinical and billing teams to stay aligned.

The Hidden Cost of Incomplete Verifications

No one talks about how eligibility errors create invisible revenue leaks—until they see their denied claims stack up. For example, we recently onboarded a Spravato clinic that was losing nearly 12% of its monthly revenue due to unverified benefits and retroactive payer terminations. Within 30 days of partnering with Finnastra, their clean claim rate rose to 99%.

When you work with a dedicated Spravato Billing Company like Finnastra, you don’t just gain a billing partner—you gain a proactive RCM shield that catches errors before they reach the payer.

This One Thing Changes Your Entire Spravato Revenue Cycle

Eligibility verification might seem routine, but it’s the foundation of every successful buy-and-bill model. Without it, even perfect coding and submission processes can crumble under denied or delayed payments. Our front-end RCM strategy doesn’t just protect your reimbursement—it safeguards your operational confidence.

Still Stuck? This Is Why

If your Spravato or TMS program is facing unexplained denials, recurring eligibility errors, or authorization bottlenecks, the issue often starts with the verification process. Finnastra’s front-end expertise ensures:

• Zero missed eligibility checks
• Clean claims from the first submission
• Faster payments and improved cash flow
• End-to-end compliance with REMS and payer policies

The Finnastra Advantage

As a trusted Spravato Billing Company, Finnastra helps mental health and behavioral practices eliminate the financial risk of buy-and-bill by mastering every step of the billing process—from eligibility and authorization to claims and payment posting.

Our clients choose Finnastra because we take a proactive, detail-oriented approach to billing—so you can focus on patient outcomes, not paperwork.

If you’re ready to strengthen your Spravato revenue cycle and stop losing money to missed verifications, visit https://finnastra.com/spravato-billing/ to learn how our team can help.