21+
Years of Experience
98%
Key Aspects of Insurance Eligibility Verification and Preauthorization
Insurance Eligibility Verification
Many claim denials occur due to inadequate verification of patient benefits. This process involves confirming the patient’s coverage, benefits, and financial responsibilities before services are provided. The key components of insurance eligibility checks include:
Many claim denials occur due to inadequate verification of patient benefits. This process involves confirming the patient’s coverage, benefits, and financial responsibilities before services are provided. The key components of insurance eligibility checks include:
- Confirming coverage: Ensuring the patient’s insurance policy is active and applicable to the services.
- Understanding coverage: Identifying what treatments, medications, and services are covered.
- Identifying patient responsibilities: Clarifying deductibles, co-pays, and out-of-pocket maximums.
Verification is necessary for all new patients, hospital admissions, those reporting changes in coverage, and high-cost procedures.
Preauthorization
Many non-emergency medical procedures require health plan approval. Securing preauthorization ensures the patient qualifies for payment coverage before services are delivered.
Count on Us for Comprehensive Insurance Verifications
Physicians often struggle to complete insurance eligibility checks promptly due to their focus on patient care. Our extensive experience in the field allows us to support you effectively.
Knowledgeable in each and every aspect of health insurance, healthcare terminologies and medical/surgical techniques, our verification specialists work with payers as well as patients to verify eligibility and obtain authorizations for services or procedures to be provided.
We perform medical insurance verifications in real-time. Our verification specialists confirm patient benefits in advance of the encounter, supporting accurate billing, enhancing care, and improving cash flow. They are well-versed in payer coverage policies, ensuring a seamless eligibility verification process for your practice.
How the Eligibility Verification and Pre-Authorization Process Works
Steps in the Insurance Eligibility Verification Process
Verify patient information with the carrier, including:
- Policy status & effective date
- Type of plan and coverage details
- Payable benefits
- Co-pays, co-insurance, & deductibles
- Plan exclusions
- Referrals and pre-authorizations
- Lifetime maximum
- Primary and secondary insurance coverage
- Claims mailing address
Steps in the Preauthorization Process
Highlights of Our Services
Choosing us as your insurance verification company can free up your staff’s time from waiting on hold with insurance companies.
- We can work directly in your software or on our own
- We stay ahead of your schedule and complete the verifications before the patient visit
- Our services are more cost-effective than hiring and training an in-house verification team
- Our team has expertise in insurance verification for various medical specialties, including dental
- Our QA process guarantees 98% accuracy. We also record the phone calls with the insurance representatives for QA purposes.
Our support helps you understand patients’ coverage, identify non-covered services, and discuss out-of-pocket costs upfront. This allows you to create custom treatment plans that align with patient needs and insurance benefits, fostering transparency and trust while preventing denials and enhancing cash flow.
We serve all 50 states
Benefits of Partnering with Us for Insurance Eligibility Verification
- Comprehensive support
- Streamlined process
- Enhanced revenue cycle efficiency
- Increased accuracy
- Faster approvals
- Cost savings
- Customized solutions
- Enhanced patient experience
- Ensures compliance
- Frees up staff time to focus on patient care
- Strengthen relationships with insurers
Pricing for Our Insurance Verification and Authorization Services
Full-Time Equivalent
