Steps to Strengthen the Insurance Eligibility Verification Process and Prevent Denials

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Oct 24, 2022

Steps to Strengthen the Insurance Eligibility Verification Process and Prevent Denials

Insurance eligibility verification services play a crucial role in ensuring a healthy revenue cycle. Did you know that most medical claim denials happen due to insurance eligibility related reasons? Well, claims get denied either because eligibility has expired or a patient or service was not covered by the plan. Having a solid insurance verification process in place can help prevent claim denials and the headaches that go along with them.

What is insurance eligibility verification?

Simply put, the insurance eligibility verification process involves getting in touch with the insurance provider to confirm if the services provided are covered under the health insurance plan. Insurance companies frequently make changes to health insurance policies. It is important to verify if the patient is covered under the new plan in order to lower the risk of claim denials and maximize reimbursements.

Let us now discuss the steps involved in the insurance eligibility verification process to reduce claim denials.

  1. Get a copy of the insurance card from the patient
  2. We all know that an active health insurance card is crucial to availing healthcare benefits. It serves as a primary document for eligibility verification too. Hence, the first and foremost step in insurance verification process is to obtain a copy of the insurance card from the patients. To be on the safer side, even if the patient says, that the insurance card copy has been submitted earlier while availing services go ahead and request for a copy. An updated image of both sides of the insurance card serves as an information backup to check for any changes or even expiry details.

  3. Insurance eligibility and verification check list
  4. Once a copy of the insurance card has been received it is important to verify and capture all the relevant information into the patient electronic health records. It includes the patient name, name of insured person, as it isn’t always the patient, relationship to the patient, relevant phone numbers, date of birth, social security number, chief complaint, name of treating physician, date of service, insurance providers name, contact number and address, type of plan, insurance number and effective date, policy coverage, co-pay and deductible details, insurance ID and group ID number, referrals and preauthorization for specific procedures, treatments and services, claim mailing address, and so on.

  5. Get in touch with the insurance service provider
  6. In order to ensure a smooth verification process it is recommended that you get in touch with the insurance provider ideally 48 hours prior to the patient’s initial visit. To start with, you can contact them directly over the phone or log in to their online portals and enter the patient’s data to verify their coverage and benefits. This ensures that you have all the information at your fingertips even before the patient walks through your door. This is the ideal stage to identify any mismatch of information and take corrective measures. Moreover, in case the electronic eligibility checks all data can be imported directly into the electronic health record systems, making the process faster and easier.

  7. Record complete and accurate information
  8. It is important to update all patient information - right from the initial appointment to the final discharge into their respective accounts with utmost care and diligence. Entering correct information and not missing out on any information lays a solid foundation to ensuring clean claim submissions. Never rush through the insurance verification process. Even a small error in patient information submitted for eligibility verification can lead to claim denials and delays. At times, double checking for accuracy may seem like a waste of time but in the long run saves practices from unnecessary insurance provider calls and follow-ups.

  9. Follow-up with the patient as needed
  10. If need be, get in touch with the patient to clarify any doubts or seek missing or additional information during the verification process. Follow-up with patients can be done either through phone calls or through email communication. Patients should be informed of any information related to co-pays, deductibles, coverage shortages etc., as early as possible. Informing them of their financial obligations well in advance ensures smooth collection of funds.

Managing eligibility and verification can be overwhelming in addition to focusing on providing high quality care. Well, what could be done? Outsourcing your insurance eligibility verification services to a reputed billing company like Scribe4Me allows you to focus on patient care without having to worry about denied claims and reimbursement issues. They have a highly skilled and trained team of insurance verification specialists who can provide accurate eligibility verification services that greatly reduce denials. And the end result is a boost in clean claim rates that improves collections and cash flow to your practice. To know more send in an email to [email protected]

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