Learn How Insurance Eligibility Verification Works

21+

Years of Experience

98%

Claim Submission Accuracy

25%

Decrease in Outstanding AR

Key Aspects of Insurance Eligibility Verification and Preauthorization

Insurance eligibility verification and preauthorization are vital steps in the medical billing process, ensuring that medical offices receive payment for services rendered across all patient encounters.

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:

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.

Ensure accurate, timely verifications and approvals! Optimize patient care, maximize practice revenue!

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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.

Count on Us for Comprehensive Insurance Verifications

How the Eligibility Verification and Pre-Authorization Process Works

Steps in the Insurance Eligibility Verification Process

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Collect the patient’s demographic and insurance details, including their name, date of birth, insurance policy number, and group number.

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Verify the patient’s Identity by checking their photo ID, insurance card, and other relevant documents.

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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

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Contact the insurance company to verify the patient’s eligibility for services via phone, mail, or web portal.

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If prior authorization is needed, submit the request to the payer to secure approvals and referrals.

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Update the patient record with verified insurance details, including coverage and benefits.

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Inform the patient of the eligibility verification results, including financial responsibility and coverage limitations.

Steps in the Preauthorization Process

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Determine if preauthorization is needed based on the patient’s insurance plan.

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Collect relevant patient information, including demographics, insurance, medical history, and the procedure.

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Prepare and submit the preauthorization request with patient data, procedure details, CPT/HCPCS codes, and medical documentation.

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Communicate with the insurance provider to check the preauthorization status.

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Review the insurer’s response (approval, denial, or requests for more info) and take necessary actions.

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Provide any additional documentation promptly to resubmit for final authorization.

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Update the patient record with preauthorization details.

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Inform the patient of the authorization outcome, including costs or coverage limitations.

Our team continuously monitors the authorization status for any updates and addresses any issues that may arise.

How We Provided Insurance Verifications and Authorizations for a Podiatry Specialty in Raleigh, NC

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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.

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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

We offer flexible pricing options to meet varying needs:

Full-Time Equivalent

In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.

Per Verification Billing

Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.

FTE/Per Verification Billing

This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.

Healthcare and Dental Revenue Cycle Management Process

Streamline your insurance verification and authorization process!

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How Insurance Eligibility Verification Works