The process of Insurance Eligibility Verification is crucial to ensure denials due to missed or incorrect information are under control. There can be several reasons for claim denial or rejection but researches have proved not having an effective Insurance Eligibility Verification is the major reason for most denials and claim rejections comparatively. Let us discuss the complete checklist for Insurance Eligibility Verification to make it more efficient and streamlined to improve the overall billing experience.
Common Denials Due to Missed Insurance Eligibility Verification
- Claim denied due to typo in the mandatory information
- Lack of mandatory information
- Incorrect or incomplete Patient Demographics Entry
- Coverage exhausted
- Service not covered
- Coverage terminated
- Policy Terminated or Expired
- Service requires Prior Authorization or referral
- Out-of-Network coverage
Insurance Eligibility Verification is greatly beneficial to identify and curb denials as listed above which is not exclusive but also more such possibilities and helps cleaner claims submission with increase first-pass rate. Therefore it is essential for any medical Billing and Revenue Cycle Management services to have a full-fledged Insurance Eligibility Verification. The best way to achieve maximized benefits is to have a checklist for a streamlined Eligibility Verification process.
A Complete Checklist for Insurance Eligibility Verification
The process of Insurance Eligibility Verification is detailed and requires fetching as much as information as possible in one go. Asking the right question is the key to efficiency, therefore having a checklist of details to be collected during verification call will yield better results. Listed below are the information to be verified and validated during Insurance Eligibility Verification:
- Insurance details like Insurance name, ID and group number
- Insurer name and Dependent details
- Policy Effective and Lapse date
- Coverage details, Coverage Policy
- Procedure to be rendered is covered
- Services under exclusion list of policy
- Practice and Provider In-Network with Insurance
- Prior Authorization and Referrals if required
- Patient responsibility like Copay, Deductibles, etc.
Verifying Insurance also helps communicate the patient responsibility clearly to the patient prior to the date of services, this not only helps in planning your patient collections; but also aims at building good patient satisfaction thereby improving your business goals.
Challenges with Insurance Eligibility Verification
Verifying and validating every patient’s insurance details per every visit can mean a lot of time and man effort to be consciously allocated to achieve the targeted results. Nevertheless, a medical practice handling patient registrations, appointments and focusing more on uninterrupted patient services can miss these crucial billing aspects. Moreover, the expertise of handling multiple claims day in and out like a standalone Medical billing company can be missing while the same is handled by the medical practice front desk or office manager. But outsourcing Insurance Eligibility Verification can help you face these challenges effortlessly.
Outsourcing Insurance Eligibility Verification
The trend of Outsourcing Medical Billing Services has been long established. An experienced Medical Billing Company has the expertise handling each scope involved in Revenue Cycle Management to ensure maximized results. They have the exposure, infrastructure, automated tools and software, manpower, expertise and experience to handle each niche with dedicated staff trained and skilled to achieve the expected quality and quantity percentage. They work towards increasing your monthly collections.
About e-care
E-care India is one of the top Offshore Medical Billing Companies based in India that promises to avoid claim rejections and denials with our Insurance Eligibility Verification. We ensure maximized monthly collection and reduce denials through a thorough verification process. To know more about e-care and its services, Call 813-666-0028 or log on to www.ecareindia.com