Eligibility and Benefits Verification
Insurance Eligibility Verification is the procedure of verifying a patient’s insurance in terms of three different statuses such as coverage status, active or Inactive status, and eligibility status.
Insurance eligibility verification is very important as it is directly linked to claim denials or payment delays of a healthcare practice, especially the account receivables (A/R).
We receive daily patient schedules from the healthcare providers’ offices/clinics through integrated EHR and Practice Management System.
Our team access the EHR and Practice Management System and verifies patient demographic information to make sure everything is accurate.
Our dedicated eligibility and benefits solutions team will verify the patient complete, accurate and active eligibility, coverage and benefits details with their primary and secondary payers along with the policy effective and termination dates and confirms the coordination of benefits among the payers and obtain PCP and Specialists copays, Co-insurance percentages, deductibles and other out-of-pocket expenses both in-network and out-of-network.
We perform this process in the first week of every month to find out if there is any change in patient’s health plan and/or IPA and update the details in respective patient accounts in EHR and Practice Management System.
