Insurance Eligibility Verification

Physicians need to verify each patient’s eligibility and benefits to ensure they will receive payment for services rendered. Insurance verification allows us to reduce billing errors, optimize collections, and reduce patient denials.

“One in five claims is denied or delayed, and a startling 90 percent of those denials are preventable.” Says ZirMed’s Dustin Hamilton.

Eliminate Claim Denials With Upfront Patient Eligibility Verification

By keeping your information up-to-date, the chances of denial decrease substantially. You can start by looking at:

  • Demographic data—is your insurance identity card up to date and correct for the date of service?
  • Coverage—Do you have valid coverage on the date of service?
  • Benefit options—Have you paid your copays and coinsurance?
  • Prior authorization requirements—Have you been authorized to receive treatment from the appropriate sources (if applicable)?

Incomplete Demographics

Incomplete or incorrect demographics lead to a huge backlog of claims. Simple things like a typo in the patient’s name or address can lead to claim denial. Correct data collected at reception ensures the patient screening process goes smoothly.

Issues in Coverage

Sometimes life gets in the way, and patients change their healthcare coverage. Make sure to review the details of a new plan when updating a policy and then have the healthcare provider desk conduct a fresh eligibility verification.

Another scenario is an expired/terminated policy, which leads to claim rejection. Staff should check the validity or expiration of an insurance policy upfront; they can prevent these types of claims from going through and address them before rejection.

Unpaid Benefits

Your insurance policy will lead to a denied claim if you have a delayed premium payment or copay. Insurance providers will only consider the claims of patients who have active policies. Once a policy lapses, patients no longer have coverage causing their claim to be denied.

Authorization Requirements

Some insurance providers will only accept a claim for certain procedures and appointments if there is an authorization or reference from the primary care specialist or similar medical specialist. If treatment is carried out without a referral, the medical claim will be denied.

 

Performing eligibility verification helps healthcare providers submit clean claims with less wait time. With insurance companies increasing premiums, cutting coverage, and increasing patient responsibility, insurance verification has become a top priority.

 

Check out our website to see how SureCollect can increase efficiency for your practice.

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