Dependent eligibility verification
How do we verify a dependent's eligibility when they are added to coverage, with the proof of relationship collected and checked before coverage is confirmed?
Make the proof a chase the member finishes on their phone and the decision a rule with a reviewer behind it. When a dependent is added (at enrollment, a life event or an audit), Callvu classifies the dependent type (a spouse, a domestic partner, a child by birth, adoption, step or legal guardianship, a disabled adult child), lists the proof the plan's rules require for that type, requests it through a link with the deadline, reads each document on arrival and checks the names, dates and relationship against the member's record, approves a matched dependent by rule, routes an unmatched, incomplete or contested case to the eligibility team in the Decision Desk with only the allowed outcomes, and writes the verified dependent with the proof and the effective date to the enrollment system of record, or the removal with notice and the member's appeal rights.
In scopeComplex: multi-party handoffsCallvu moves: chase and verify, decide, write back
Last updated November 7, 2026.
The problem today
The audit found that one dependent in twelve had no proof on file, and the letters asking for it went to addresses the plan last confirmed four years ago.
Dependents are added on a member's word at enrollment, and the proof is collected later, by a vendor, in a one-time audit with letters and a deadline. Members who miss the letter lose coverage for a child who was eligible; members who never qualified have been covered for years. The eligibility team handles appeals by phone with no documents in front of them.
The plan's rules define each dependent type and the proof for it (a marriage certificate and proof of joint residence for a spouse, a birth certificate for a child, adoption papers, a court order for guardianship, a disability certification for an adult child), the deadline to supply it, and the consequence of not doing so. The federal rules protect dependents to age twenty-six and set notice and appeal rights when coverage is rescinded or ended. Verifying at the moment of adding, with the member's phone as the scanner, replaces the audit.
Proof at the door costs the member two minutes; proof in an audit costs the plan a year of claims.
How it runs
From the requestto the system of record.
A dependent is added through enrollment or a life event, or a verification cycle selects a dependent without proof on file. Callvu classifies the dependent and opens the verification.
- Member
- Uploads the proof for each dependent through a link and responds to specifics.
- Eligibility team
- Decides unmatched, incomplete and contested cases in the Decision Desk.
- Callvu
- Classifies, lists the proof, chases, reads and checks, approves by rule, routes and writes.
Classify and list the proof
The dependent's type (spouse, domestic partner, biological or adopted child, stepchild, child under guardianship or a court order, disabled adult child over the age limit) is classified from the enrollment, and the plan's proof for that type is listed: the documents, whether a recent joint document is required for a spouse or partner, the disability certification and its renewal for an adult child.
Chase and verify
The proof is requested through a link with the deadline and plain instructions (what to photograph, what may be redacted), read on arrival and checked: the names against the member's and the dependent's records, the dates of birth and marriage against the enrollment, the relationship against the type, a court order's terms and dates; what is missing or does not match is requested with the specifics, and reminders go until the deadline.
Decide
A dependent whose proof matches is approved by rule with the effective date; an unmatched name (a surname change, a translation), an incomplete set at the deadline, a contested relationship, a disabled adult child certification or a domestic partner under the plan's affidavit rules goes to the eligibility team in the Decision Desk with the documents and only the allowed outcomes: approve, approve pending a named document by a date, or remove with notice and the appeal rights.
Write back
The verified dependent with the proof, the type and the effective date is written to the enrollment system of record, or the removal is written with its effective date, the written notice to the member with the reason and the appeal rights, and the claims system informed; a periodic re-verification (an adult child's disability, a domestic partner's status) is scheduled from the record.
Where it ends: Every dependent on coverage has proof checked against the member's record, matched cases were approved by rule, the eligibility team decided only the rest with the documents in view, and the enrollment system of record holds the proof and the effective dates. The Decision Trace shows the type, the proof required, each check and any decision; the Audit Trace shows the requests, the uploads and the write.
Runtime enforcement
What is enforcedwhile the work runs.
The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.
The handoff
Between the front doorand the back office.
The front door
The enrollment or life event flow, or the verification link sent to the member's phone.
The back office
The eligibility team sees only cases that need a person, with the documents checked; no audit vendor letters.
The Decision Desk
- An unmatched name, an incomplete set at the deadline, a contested relationship, a disabled adult child certification or a domestic partner affidavit goes to the eligibility team in the Decision Desk with the documents and only approve, approve pending a named document, or remove with notice and appeal rights.
Proof
In scope.Proof at scale, not one process at a time.
The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.
23 hospitals in the Ministry of Health network run on Callvu.
Across Callvu customers
More than 1,000 processes are live across Callvu customers.
Across Callvu customers
Questions
What buyers ask next,answered plainly.
What proof is required?
What the plan's rules set for the dependent type: a marriage certificate and a joint document for a spouse, a birth certificate for a child, adoption or guardianship papers, a disability certification for an adult child; listed when the dependent is added and uploaded by phone.
What happens if the proof is not supplied?
After reminders and the deadline, the eligibility team decides with what was received; a removal is prospective with written notice and the appeal rights, not a retroactive cancellation unless fraud is shown.
Is anyone involved for a normal case?
No. Proof that matches the member's record approves the dependent by rule with the effective date; the team decides only the exceptions.
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