Patient Insurance Eligibility Verification

How will implementing electronic eligibility verification improve your practice’s workflow?

Insurance Eligibility Verification is more critical today than ever with the advent of the Affordable Care ACT. In today’s insurance eligibility verification reality an ACA patient can have insurance one month and not pay their premiums in month 2 and 3. Qualified health plans are required to pay all claims for services rendered in the first month of the grace period (eligibility).Carriers will spend claims in the second or third months, at which point the patient must pay the provider for service already rendered or pay their insurance premium. If the patient cannot afford the payment for their premium, then any physician claims pending during this second and third month will go unpaid causing an increase in bad debt collections.
The process of obtaining the insurance eligibility verification of a patient is necessary to insure that the patient has coverage, services that are being provided are covered, denials and appeals can be minimized and payments are expedited at the appropriate rates. Denied claims due to no active coverage, out of network, unauthorized patient procedures or visits can be a major loss in revenue and should not be taken lightly.

Insurance Eligibility Verification Services We Offer

Our team includes skilled and talented insurance specialists who are always geared to serve you. Some of the services that we offer are –

Health Insurance Document Verification

Once we receive all the necessary documents from the healthcare organization, our team analyzes the insurance E&B a day before the scheduled appointment to ensure that the records are verified. We collate the paperwork in sequential order as demanded by the insurance provider

Patient Insurance Coverage Verification

We verify the patient’s insurance coverage with the primary and secondary payers. They capture details like co-insurance, copay, deductible, PCP name matching, in-network, and out of network benefits, and update in the patient notes. Then, our team completes the verification process by accessing the insurance provider’s online portal or by directly calling them over the phone.

Patient Information Correction

Our insurance support executives also follow-up with the patients and call them for any incorrect or missing information/documents. This helps to keep a track of filed/unfiled information and verifying all the collated information prior to the final submission.

Claim Submission

Lastly, we conduct a service procedure check and need authorization before providing the final claim details to our clients. It includes the required documents and other relevant information such as member ID, group ID, insurance coverage dates, copayment (co-pay) information, etc.

Our Staff will contact the patient’s health insurance carrier to get the following information for medical eligibility checks:

  1. Patient is indeed covered by the insurance

  2. Insurance coverage effective dates

  3. In-network or out-of-network coverage

  4. Service(s) you are seeing the patient for are covered. Do they need pre-authorization and/or a referral by a primary care physician?

  5. Amount of co-pay for services, if any

  6. Deductible amount–has the deductible been met for the year?

When the patient arrives for their appointment, you’ll want to make a copy of their photo ID and their insurance card and collect any applicable co-pay.

Our Insurance verifiers make sure that these items are verified:

  • Payable benefits

  • Co-pays

  • Co-insurances

  • Deductibles

  • Patient policy status

  • Effective date

  • Type of plan and coverage details

  • Plan exclusions

  • Claims mailing address

  • Referrals & pre-authorizations

  • Life-time maximum, and more

When the patient arrives for their appointment, you’ll want to make a copy of their photo ID and their insurance card and collect any applicable co-pay.

The Benefits of Eligibility Verification Services

Let our team be an extension of your office and handle your eligibility verification in a more timely manner. Free up time for your staff to concentrate on delivering fast and patient-centric service. Decrease the number of upset patients by letting us handle the eligibility checks. Increase the number of patients seen each day through a more streamlined front-of-house.