Eligibility Verification
Eligibility verification helps healthcare professionals to submit clean claims. It avoids claim re-submission, reduce demographic or eligibility related rejections and denials, increase collections, leading to improve patient satisfaction. Also, verifying authorization requirement before the service avoids denials, and contributes to increase in collections. We receive our workflow through the work log, EDI logs, Fax, emails, and FTP files. We then verify primary and secondary coverage details, including patient ID#, group ID, coverage period, co-pay, deductible and co-insurance information, and benefit information. We call or review web portals to connect with the payer. We contact the patient, in case of missing or invalid information.
Issues on account of lack of strong eligibility and benefits verification processes:
- Reduction in clean claims ratio
- Claim denials and consequently rework
- Delays in payment from healthcare payers
- Reduction in the profitability of the practice
Our eligibility and benefits verification and associated services
We deploy the people, technology and apply our experience to ensure accurate determination of insurance eligibility. Our services include:
- Receive Patient Schedules from the healthcare provider
- Verify coverage on all primary and if applicable secondary payers by utilizing payer websites, and IVR systems
- As required, we make calls to payers to check the eligibility status and patients for additional information
- Update the results on the practice management system – update member ID, group ID, coverage start and dates, copay information and much more
- We also provide additional services such as reminding the patient of the POS collection required, obtaining referrals from Primary Care Physicians (PCPs)