Insurance Eligibility Verification

Insurance eligibility verification is a crucial step in the initial stages of the revenue cycle management and medical billing. This would tell us how much the insurance will be able to cover for the costs of the services provided to the patient. Thus, we can inform the patients upfront, for the charges that they have to bear, if any. This would speed up the money inflow avoiding denials.

Insurane Eligibility Verification Services

What is Insurance Eligibility Verification?

Insurance verification is a process which includes validating and verifying the coverage, benefits and co-payment details of the patient and obtaining pre-authorisation. It is important to complete this medical insurance eligibility verification process before the treatment and medical services are provided to the patient. This enables faster payments and improves patient satisfaction. Failure in this step could end up in a huge unpaid claim from the insurance company and also burdens the patient with unforeseen heavy bills to settle.

Another challenge in this step is that many a times, the patient provides the medical insurance details which are outdated. It becomes difficult for the health care service providers to validate the details and confirm if the patient is really eligible for the benefits or not.

Insurance Eligibility verification at BIS

We at BIS, with our dedicated and experienced medical billing team offer efficient Insurance Verification billing services to check the insurance eligibility and service benefits. We reach out to the insurance company and check for payment clauses wherein the patients need to oblige to and pay prior or post the treatment.

If we identify any such coverage issues prior to patient treatment, we would appraise the service provider. Accordingly, the health practitioner team can discuss the same with the patients and get the payment options from them during their initial visit or appointment.

We do an exhaustive medical insurance verification which includes but not limited to:

• Policy carrier

• Policy Status (Active or lapsed), including the period of coverage

• Type of plan

• Policy Construct

• Age covered (maximum period)

• Family definition and members covered under the policy

• Policy owner’s contact credentials

• Coverage details including what illness and services are covered and what services are excluded

• Policy payment clauses

• Deductibles

• Co-pay details

• Waiting period clauses

• Pre-existing diseases clause

• Referrals

• Pre-authorization and claim submission

• Any other relevant information required

We at Business Integrity Services, with our dedicated and experienced medical billing team offer efficient These data are collected, verified and validated before the patient’s treatment is started. It helps in getting the necessary referrals, prior authorization codes, and enhancing the insurance verification process in medical billing services. As mentioned earlier, it plays a vital role in preventing denials due to invalid benefits and eligibility reasons as well.

After the insurance eligibility verification is complete, the patient visits the healthcare provider, and appropriate treatments are rendered.

An effective health insurance verification process thus:

1. Improves Cash Flow by ensuring submission of increased clean claims which are processed faster and has quicker turn-around time.

2. Reduces a significant percentage of rejections and denials from the insurance companies which cannot be corrected and sent for reclaim unlike the coding errors.

3. Reduces the bad debt arising due to huge unclaimed services provided

4. Improves and enhances patient satisfaction levels. When they are informed about their payment responsibility well in advance, they are prepared to pay their bills on time, thus leaving out the frustration, anguish and disappointment of last-minute information about the payments.

5. Impacts and increases the bottom line of the company when payments are collected faster without delays and denials.

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