Health insurance companies use a variety of methods to verify claims and ensure accurate reimbursement.

For direct billing claims, the verification process happens directly between the network hospital and the insurance provider. The hospital submits the claim details to the insurer, who then ensures patient eligibility, and processes the claim for payment. Nowadays, the verification is often automated through specialized insurance claims management software systems that manage the end-to-end claims process, from initial submission to payment. This allows the insurance provider to electronically validate the patient's eligibility, review the medical documentation and procedure codes, and process the claim for reimbursement to the healthcare provider.

In contrast, for reimbursement claims where the patient pays out-of-pocket first, the insurance company verifies the details directly with the customer. They review the medical records, codes, and charges submitted by the patient to confirm the services were medically necessary and billed correctly.