Why DME Providers Can’t Risk Going Into January 2026 Without AI Eligibility Verification

The Data Is Telling: Manual Eligibility Is Breaking DME Revenue Cycles

Study after study tells the same story:

30–40% of claim denials stem from eligibility or registration errors, making them the #1 avoidable source of revenue loss every year.

And during Open Enrollment, denial volatility increases even further:

For DME providers, the downstream impact is even more brutal, as a single eligibility error can wipe out months of revenue.

That’s why January is the most critical month for DME providers.

Open Enrollment isn’t just a seasonal eligibility reset. It’s a window that determines how predictable (or vulnerable) your revenue will be next year.

The #1 Mistake DME Providers Make Every January

Open Enrollment resets the very rules your revenue depends on:

Yet most DME providers continue billing using last month’s eligibility data, and that’s where the bleeding starts:

When eligibility isn’t verified every cycle, you’re bound to stare down:

And by the time your team backtracks the root cause, you’ve already lost the billing cycle and possibly your revenue too.

Manual Eligibility Verification Can’t Keep Up. Not Anymore.

Manual checks simply can’t keep up with payer complexities or the velocity
of updates happening during Open Enrollment.

And the fallout is brutal:

AI Eligibility Verification: The Shift DME Providers Must Make Now

AI eligibility verification eliminates the guesswork, rework, and manual grind that break DME claim cycles every January.

That’s because AI doesn’t just “check eligibility,” it verifies eligibility and flags revenue risk before you bill.

And this is exactly where Anka comes into the picture—pushing AI's boundaries to autonomously carry eligibility verification end-to-end.

Meet Anka

Jindal Healthcare’s Agentic AI Built to Protect DME Revenue Every Cycle

Anka is engineered for the real-world chaos DME providers face during Open Enrollment and beyond.

It is a purpose-built AI eligibility verification solution that verifies eligibility in real time, tracks payer shifts, and updates your workflows, proactively preventing denials and protecting your revenue.

What Makes Anka a Game-Changer in Eligibility Verification

Re-Verifies Eligibility Every Billing Cycle

Connects to your payers via API, EDI, and portal automations to re-verify eligibility every cycle and detect hidden coverage changes early—eliminating guesswork, reducing eligibility-related denials by 90–95%, and saving your practice thousands every month

Accurately Interprets Complex EDI Responses

Integrates with clearinghouses, including Availity and UHC portals, to receive 271 responses; uses trained models to decode complex EDI—mapping nuanced benefits, modifiers, exceptions, and payer-specific quirks—into a clear, standardized format

Performs Payer Calls Autonomously

Leverages Voice AI to execute fully automated call workflows that dial payers, navigate IVRs, verify benefits, and document outcomes—eliminating staff involvement and ensuring accurate, reliable eligibility verification every cycle

Identifies and Alerts Documentation Gaps

Pulls documentation timelines, checks them against payer rules, and alerts you when something expires or is missing—preventing denials and last-minute staff scrambling 

Calculates Estimated Patient Responsibility (EPR) Upfront

Uses EDI, portal, and payer-call data to compute deductibles, co-insurance, and OOP limits with precision—eliminating billing errors and accelerating collections

Reduces Staff Workload by More Than 90%

Performs batch verification, multi-payer checks in real-time—removing nearly all manual steps, reducing your staff workload by over 90%, and saving them time for high-value tasks

Anka isn’t just automation; it’s intelligent eligibility verification
engineered for DME revenue protection.

Why DMEs Reliant on Manual Verification Need AI More Than Ever

Manual verification looks inexpensive until it starts costing you
your revenue every month.

The Most Important Move DMEs Must Make Before January 2026

Open Enrollment isn't just a busy quarter in healthcare; it’s a financial game-changer for those who adapt and evolve to lead with confidence.

Smart DME providers are already pivoting to AI with Anka to lead 2026 with:

Take Charge of Your Revenue Before Open Enrollment Does It for You

With Anka, every claim enters the billing cycle validated, documented, and payer-ready, regardless of payer changes, plan resets, or coverage churn.

Book a Demo

See how Anka keeps your eligibility verification accurate every cycle, so your revenue stays protected every month.