Start 2026 Strong: Why Radiology Leaders Are Prioritizing AI Eligibility Verification This Month

For radiology groups and imaging centers, the Open Enrollment coverage shake-up comes with outsized financial consequences, as it triggers:

3-5X

more plan changes

20-30%

spike in eligibility denials

$40-$120

to appeal or correct a denied claim

One eligibility error, one missing prior authorization, one unnoticed silent payer switch, and suddenly the scan that costs you thousands to deliver turns into zero reimbursement.

This is because radiology is one of the few specialties where revenue is determined before the patient even hits the scanner.

Why Radiology Groups Are Especially Vulnerable

Radiology revenue is built on top of eligibility correctness. Thus, your risk is higher when eligibility verification is compromised due to:

Front-end fragility and operational pressures like:

Tight scheduling windows that leave no room for thorough
verification

High volume of MA/Medicare patients with frequent imaging needs & churn

Last-minute referrals and high documentation requirements

Which result in:

30–40%
of denials originating from eligibility errors
9%
of denials tied to missing prior authorization critical for MRI, CT, PET

These factors make radiology uniquely exposed to coverage changes. That’s why strengthening eligibility verification before 2026 isn’t just a smart move. It’s critical for protecting revenue from preventable denials and downstream revenue loss.

What January Really Looks Like for Radiology Providers

As someone from radiology, you already know the drill:

Eligibility Verification Should Match Radiology Precision

Manual checks simply can’t keep pace with payer complexities and shifts in real time. They aren’t just slow; they are risky and unsustainable too because:
  • Scheduling is real time.
  • Authorizations are high stakes.
  • Volume is non-stop.
  • Referrals are last-minute.
  • Patient expectations are immediate.
  • Lost Revenue: One miss costing months of payments
  • Aging AR: Claims slipping deeper into the 90+ bucket
  • Staff Burnout: Staff spending hours correcting errors
  • Compliance Exposure: Eligibility issues triggering audits
  • Cash Flow Volatility: Payments becoming unpredictable

No radiology group can sustain this level of leakage—not in 2026.

The #1 Mistake Radiology Groups Make

Billing on outdated eligibility data instead of verifying data every billing cycle.

When eligibility isn’t verified in real time, radiology providers absorb the financial hit with:

  • Recurring denials
  • Rework loops
  • Delayed payments
  • Avoidable Write-offs

By the time your team traces the root cause, the billing cycle and your revenue is already lost.

Why AI Is Becoming the First-Line Defense in Radiology RCM

Radiology requires objectivity, speed, and precision—and so does eligibility verification.
It demands RCM intelligence that’s built for the speed, modality mix, and documentation complexity of radiology. You need a solution that:

Understands your payer responses

Detects nuanced changes in real time

Resolves the issue at its root

And this is where Anka acts like your first-line defense—bringing unmatched AI efficiency and agility to eligibility verification to safeguard your revenue from the start itself.

Meet Anka: Jindal Healthcare’s AI Purpose-Built for Eligibility Verification

Unlike primary care, radiology is a high-stakes, high-volume specialty where every eligibility error is expensive.

Anka is engineered for radiology realities and the unique challenges imaging providers face during the Open Enrollment period and beyond.

It is a purpose-built AI eligibility verification solution that verifies eligibility in real time, protecting revenue and preventing denials even before they reach billing.

How Anka-Powered Eligibility Verification Protects Radiology Revenue

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, multipayer 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 radiology revenue protection.

The ROI Case for Radiology Practices and Groups

Manual Eligibility Verification
Anka-Powered Eligibility Verification
Occasional checks
Re-verifies every billing cycle
Missed plan/coverage changes
Auto-detects payer updates
Struggles with EDI responses
Interprets EDI responses with accuracy
Reactive denial fixing
Predictive alerts before submission
High staff workload
24/7 automated verification engine

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

Why Acting Now Matters More Than Ever

Radiology revenue is already vulnerable, and Open Enrollmentinduced eligibility churn can impact it further unless you’re prepared. 2026 will reward those who prepare early. And those who are embracing AI eligibility verification with Anka will lead 2026 with:

  • Zero-January Surprises
  • Lower Front-End Fatigue
  • Cleaner Scheduling Workflows
  • Better Managed Prior Auth Pathways
  • Reduced Eligibility-Related Denials
  • Stronger Compliance & Cash Flow

Take Charge of Your Imaging Revenue Before Open Enrollment Does

Radiology is too specialized, too high-volume, and too financially exposed to gamble on outdated eligibility, especially when one eligibility error can erase the entire scan’s value.

With Anka, you eliminate eligibility blind spots, bringing scanner-level precision to your front-end workflows.

Book a Demo Today

And see how Jindal Healthcare’s AI, Anka, keeps eligibility verified every cycle, so your revenue stays protected all year long.