Insurance Eligibility Verification
What is insurance eligibility verification?
Insurance eligibility verification is the most important and the first step in the medical billing process. Insurance Eligibility Verification is the procedure of verifying a patient’s insurance in terms of three different statuses such as coverage status, active or Inactive status, and eligibility status.
Insurance eligibility verification is very important as it is directly linked to claim denials or payment delays of a healthcare practice, especially the account receivables (A/R).
Process
Receive Schedules of patients via EDI, email or fax or check them every day in the
appointment scheduling software.
Verify patients’ insurance coverage with primary and secondary payers by making calls to the payers and checking through their authorized online insurance portals. We also contact patients for additional information, if required
Update the medical billing system with eligibility and verification details such as member ID, group ID, coverage period, co-pay, Deductible and co-insurance information and other code level benefits information including max limits allowed.
In case of issues regarding a patient’s eligibility, we inform the client immediately.
Services
- Insurance verification checklist
- Get a copy of the patient’s insurance card
- Contact the insurance provider
- Record accurate information
- Follow up with patient as needed
Benefit
- Clean claim submission
- Increased cash flow
- Efficient workflow
- Increased Self-pay Revenue