Importance of Insurance Eligibility Verification
Insurance Eligibility Verification helps achieve accurate insurance coverage and benefit details prior to the Patient encounter and medical procedure, which in fact helps during the revenue cycle management services to ace up the billing process and also in guaranteed reimbursement from insurance. In case of procedure not covered under the given insurance policy, this process also helps the physician understand the patient responsibility to avoid payment loss.
While the importance of Insurance Eligibility and Benefit Verification is clearly proved; results can be guaranteed only with effective and efficient process in place. Below step by step process can help optimize Insurance Eligibility Process for guaranteed results.
Checklist for Insurance Eligibility Verification
- Insurance policy start and lapse date
- Insurance coverage details like coverage amount, procedures covered, services exhausted and applicable patient responsibility
- Beneficiary and dependent details
- Provider and practice in network with the insurance
- Copay, deductibles and co-insurance details
- Procedure requires Prior Authorization and referrals
- Policy limitation and exclusions
- Documentation required for claim processing if anything exceptional
Procure Patient’s Insurance Card Copy
Verification Process
- Using Integrated EMR and Billing system to contact Insurance and verify
- Using Phone call using provider hotline number
- Setting up Electronic Eligibility Verification system
Collect and Note accurate data
During Insurance Eligibility Verification it is essential to follow the checklist and get the most without having to follow up again. Updating the EMR and Billing system with the updated changes in the insurance details is mandatory.
With an experienced and effective Insurance Eligibility Process in place claims denial completely curbed to bring down the denial ratio radically and thereby guaranteeing maximum reimbursement.
About Elegance Healthcare LLC
Elegance Healthcare LLC is a national Medical Billing Company over 7 years. With our experience and expertise in handling every niche of Medical Billing and Revenue Cycle Management services for more than 600 physicians across the US, we can take up any scope of services with minimal transition timeline. Our quality billing ensures increased claims first pass rate and reduced denials.
