Insurance Eligibility Verification Made Accurate and Fast

The cost will vary according to the scope and complexity of the work. We can fix a price either per FTE or per transaction. The more time it takes to complete a transaction, the higher the cost. Additionally, we can also provide a 1-week trial period without any costs involved, upon which we can mutually agree on the pricing.

Healthcare insurance verification results in better cashflow as claims are quickly processed and accepted, thus eliminating write-offs and claims denials. Also, if the eligibility verification process is smooth, eligibility responses can be concisely and consistently viewed. This means that the eligibility verification results are attained more efficiently, leading to fewer denials and misallocation of resources. Finally, outsourcing healthcare insurance verification results in faster billing cycles because of reduced payment delays that are caused by claims denials.

Insurance verification should ideally be conducted prior to the patient visiting the medical care facility for treatment or medical procedures. This way, the healthcare provider and the patient are both aware of their financial responsibilities and whether coverage is in fact in place for the treatment. Without proper insurance verification and coverage, all medical claims may be denied, and payment must come out of the patient’s pockets.

Some reasons for claims rejections post insurance verification include inactive patient coverage, changed insurance plans or providers, medical services covered are non-covered benefits, patient insurance involves out-of-network coverage, or the medical services provided needed pre-authorization.

All eligibility checks are made through a variety of ways. Eligibility checks made over the phone require that our experts only speak to human representatives because automated systems do not always provide reliable or complete patient information. Checking the insurance carrier’s website is another way to determine coverage. Finally, some clearinghouses and practice management systems are capable of verifying patient eligibility on your behalf as well.

There are many medical insurance verification software in the market that can deliver results instantaneously (in real-time) or take just a few seconds depending on which software you choose to use. Alternatively, detailed insurance verifications by phone will take approximately 30 minutes.

Insurance verification is usually triggered when medical services or procedures are required during a hospital or healthcare practice visit. Medical insurance verification can obtain critical patient information from the number of visits left to the deductible amounts involved. Ideally, insurance benefits should be verified at least once a year, particularly when the insurance plan changes or is due for renewal.

Our experts access online verification portals or call the insurer to get the necessary patient information to put in a medical claim. Our team verifies benefits and procedure-specific coverage and also obtains all the required referrals and authorizations. Some of the details we ensure that we verify include payable benefits, deductibles, type of plan, and effective dates. We also check the co-insurance, coverage details, patient policy status, plan exclusions, DME reimbursements, out-of-network benefits, and health insurance caps involved.