Eligibility and Benefits Verification
Eligibility and benefits verification is crucial for ensuring accurate and timely receipt of information regarding insurance coverage, and determining the patient’s liability to pay for healthcare services.
Even so, many healthcare providers do not pay the needed attention to eligibility and verification process.
Accurate determination of the patient’s eligibility allows healthcare providers a clear view on patient’s coverage, out-of-network benefits and insurance information.
Verification of eligibility helps healthcare providers submit clean claims and reduce demographic or eligibility related rejections and denials.It will also result in increase upfront collections; leading to improved patient satisfaction. Also, verifying authorization requirement before the service avoids denials, and contributes to increase in collections.
As part of the process. the patient list, a copy of the insurance card and demographic details are sent to us via email/fax or secure FTP. Our medical billing specialists call up the insurance company prior to the appointment. Pre-certification is done for specific lab tests, diagnostic tests, and surgeries. The details are sent to the hospital/clinic in the prescribed format.