Insurance Eligibility Verification in Medical Billing

Reduce Ineligibility, Improve Cash Flow

Insurance Eligibility Verification Made Accurate and Fast

If you are looking for new ways to revamp your RCM model to remain competitive, you need to focus on one of the front-line components of a well-oiled revenue cycle process - insurance verification process. It’s a process that has transcended the age-old practice of simple eligibility check to become an advanced process that requires the services of experienced staff with proper understanding of payer benefits systems.

MedBillingExperts has over 10 years of experience in helping healthcare practices reduce their accounts receivable cycle and increase revenue. We have primarily achieved this by blending our domain expertise with advanced functioning methodologies to keep non-payment, rework, delayed payments and ineligibility at bay.

Insurance verification process at MedBillingExperts is driven by staff, with wide experience in handling the end-to-end requirements of insurance verification, and a well-defined process to confirm coverage and benefits from different sources - integrated eligibility inquiry to individual payer websites - for accuracy of claims submission and highest degree of patient and provider satisfaction. Our clients leverage our expertise to standardize admission process and guarantee faster turnaround times

While our experience in insurance eligibility and benefits verification insulates you from costly write-offs and denials, our superior process workflow reduces your time to generate clean claims. In addition, our expert insights can help you drive top-line growth thus enabling you meet market demands and customer satisfaction hand in hand.

What will MedBillingExperts’ team do for you?

  • Ensure benefits for all patients prior to submitting to the insurance company for approval
  • Verify patient information with the insurance carrier
  • Verify patients’ insurance coverage on all primary and secondary payers
  • Complete appropriate criteria sheets and authorization forms
  • Contact the insurance companies via phone, facsimile or online portal to obtain approval for your authorization request
  • Contact insurance agencies for appeals, missing information to ensure accurate billing

Features of Our Insurance Verification Process

  • Dedicated verification specialists with strong core competencies; experience and certifications
  • Leverage all available methods to verify insurance coverage – calling Payers, scanning through payer websites, utilizing a clearinghouse site etc.
  • Cross check eligibility during all the critical stages of patient treatment i.e. from scheduling to pre-registration and from registration to pre-billing
  • Follow basic components of verification i.e. collecting insurance details, contacting carriers, determination of limits, identifying exclusions, submission guidelines etc.

Explore Here Our Insurance Verification Services

Document Checking

All the documents that we receive from the healthcare organizations as well as the insurance providers are thoroughly analysed and verified against the list of the necessary documents. This process helps us to properly authenticate and organize the documents as per the needs of insurance companies.

Verifying Patient's Insurance Coverage

We check and validate the coverage details of individual patient with the primary as well as secondary payers either by contacting them directly or verifying via official online insurance portals.

Details such as the effective date of the policy, which procedures, diagnosis and services are deemed covered, and the policy’s limitations and exclusions need to be collected systematically. Also, any required pre-authorizations or referrals are noted at this point. Finally, the patient’s co-pay and deductible amount are also confirmed in this stage.

Patient Follow-up

We are leverage all modes of communication to promptly contact the patient to seek details regarding additional, incorrect and missing information whenever required. This way we can keep a tab on all the information and cross-verify those details before the final submission.

Once the benefits have been listed and the policy limitations have been outlined, it is imperative that we follow-up with the patients and ensure they understand their financial responsibilities if they choose to go through with the medical procedures.

Final Submission

Our final submission report covers complete benefit breakdown along with other crucial details related to member ID, group ID, start and end dates of the insurance coverage, co-pay information, and so on.

Information such as whether the procedure is medically necessary and if any pre-existing conditions already exist will also be included in the final report. The final report will also contain any pre-authorizations that may need to be obtained to ensure that insurance coverage will be in place.

Other Related Services We Provide:

  • Obtain Pre- Authorization Number : We contact the payer to get the pre-authorization number required to confirm that the medical procedure or services have been approved for reimbursement.
  • Obtain referral from PCP : Our experts contact the appropriate parties to obtain the right referrals from the Primary Care Physician for the medical procedures to be completed.
  • Enter/update Patient demographics : Our trained resources update all patient demographic data by consistently following-up with patients and collecting any missing data that may have been left out of the forms by mistake.
  • Remind patient of POS collection requirements : We specialize in reminding patients of the payment collections requirements and financial obligations they have taken on when they come in to receive their medical services or procedures.
  • Inform client if there is an issue with coverage or Authorization : In the event of any issues with the insurance coverage dates or other inconsistencies, we inform the patients so that they can make informed decisions on the out-of-pocket expenses.
  • Medicaid Enrolment : Our experts reach out to patients to confirm whether they are covered by Medicaid. If not, they help them with enrolment so that insurance coverage is afforded.

Our Medical Insurance Eligibility Verification Process

Medical Insurance Eligibility Verification Process

  • Receive schedules from healthcare organizations via fax, email or EDI
  • Verify coverage on all Primary and Secondary (if applicable) Payers via phone calls to Payers or through Payer Web Sites
  • Contact patient for additional information whenever required
  • Submit final report on insurance eligibility and benefit verification along with details related to
    • Type of plan and coverage details
    • Medicare coverage
    • Payable benefits
    • Co-pays
    • Co-insurance
    • Deductibles
    • Patient policy status
    • Effective date
    • Plan exclusions
    • Health insurance caps
    • Out of network benefits
    • DME reimbursement

What Makes Us Different

  • Comprehensive or Independent Service Insurance verification service offered as part of the full revenue cycle management or as a ‘stand-alone’ service as per client needs.
  • Two Level Verification Service We provide both basic and second level insurance eligibility verification. In second level service we gather ‘code specific’ eligibility with annual max or lifetime limits and authorizations.
  • Improve Existing Process Communicate and update registration staff and propose solutions to improve eligibility verification process
  • Reliance on Technology Dependence on electronic verification that allows for both individual and batch processing of eligibility inquires.
  • Complete Documentation Assistance Guide you through proper documentation to eliminate the risk of inaccurate, incomplete, or out-of-date information.

Why Outsource Medical Insurance Eligibility Verification Services to MedBillingExperts?

Here are some of the benefits that you can reap, when you outsource insurance verification services to an expert offshore insurance verification company such as MedBillingExperts:

  • Up to 40% reduction on operating cost
  • Guaranteed 99.98% accurate verification services
  • 30% improvement in account receivable time
  • 30% quicker turnaround time
  • Complete insurance data security and 100% HIPAA compliance
  • Increased number of clean claims
  • Increase in cash collections by reducing write-offs and denials
  • Robust infrastructure

FAQ’s on Insurance Eligibility Verification

Insurance verification is the process of contacting the insurance company to determine whether a patient’s medical insurance coverage and health benefits cover the required procedures and treatments or not. Some of the information that the healthcare provider requires includes demographic data, policy limitations, benefits or co-pays involved, coverage and deductibles, and restrictions and prior authorization for treatments from the appropriate sources. Insurance verification is critical in revenue cycle management, as without adequate coverage, medical services may be provided, but never paid for. Insurance verification is key to determining how much money is owed for each type of service provided, as well as which individual or entity is responsible for paying it off.

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.

FAQs on Revenue Cycle Management Services

When you outsource insurance verification services to MedBillingExperts, you’ll partner with an expert patient insurance verification company that is focused on improving the accuracy and efficiency of your process.

Contact us today and discover the advantage of outsourcing insurance verification services to MedBillingExperts.


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