ecare India Blog

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

1. Claim denied due to typo in the mandatory information
2. Lack of mandatory information
3. Incorrect or incomplete Patient Demographics Entry
4. Coverage exhausted
5. Service not covered
6. Coverage terminated
7. Policy Terminated or Expired
8. Service requires Prior Authorization or referral
9. 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:

1. Insurance details like Insurance name, ID and group number
2. Insurer name and Dependent details
3. Policy Effective and Lapse date
4. Coverage details, Coverage Policy
5. Procedure to be rendered is covered
6. Services under exclusion list of policy
7. Practice and Provider In-Network with Insurance
8. Prior Authorization and Referrals if required
9. 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.

How To Make Your Insurance Eligibility Verification Process More Efficient?

Insurance Eligibility Verification is the initial and most significant step in the revenue cycle management process Without the eligibility verification process, it’s difficult to communicate with payers and determine the payer responsibilities. These difficulties can increase the number of errors during the claims submissions and also increase the average A/R days & lowers the business revenue. Let us discuss how to process insurance eligibility verification more efficiently.

Insurance Eligibility Verification 

Insurance eligibility verification is the process of checking the patient’s insurance coverage status, eligibility status, etc. Here listed Below is the checklist of information to be verified for a smooth and productive billing of each claim. Type of Medicare coverage

• Coverage dates
• Patient demographics
• Benefit options – including patient responsibilities for co-pay, co-insurance & deductibles
• Individual plan deductible and deductible remaining
• Family plan deductible and deductible remaining
• Referrals and pre-authorizations
• Claims mailing address
• Lifetime maximum
• Address for claims submission
• In-network or out-of-network status
• Durable medical equipment coverage

Without verifying this information, healthcare services may be wrecked. Eligibility verification is of paramount importance as any deficiency may lead to claim denials and account receivables delays etc. The major reason for claims denials and delays is that insurance eligibility verification is not done accurately.

Optimize Insurance Eligibility Verification Process

Here are some of the  techniques that can be followed to make the insurance verification process work effortlessly:

Check the patient’s insurance coverage with the payers by reaching the administrators through calls, Interactive Voice Response (IVR), and portals. 

Updating e patient data accurately is essential. Our medical billing team gathers the patient details and gets the eligibility verification, claims details, etc. If any issues found during the eligibility verification process, the issue ought to be set out to avoid denials. Through the eligibility verification process, any miss in the patient data or the claims get updated and claims submitted error-free.

Outsourcing Makes Your Practice More Efficient

Outsourcing free up the workforce to focus on progressively productive tasks, and meanwhile improve payment and collections. The redistributed firm that you will work together with will focus on accelerating approval and co-ordinate with the insurance company concerning pending claims. Outsourcing engages you to have better control of your business. It will make your practice effective and ensure smooth working with staff and smoothed out a business process. 

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.

Why Outsourcing Insurance Eligibility Verification Services Is A Good Choice?

Insurance Eligibility Verification is the process of verifying the patient’s insurance coverage details and its authenticity with the Insurance Company. Insurance Eligibility Verification should be done prior to the patient’s appointment with the physician to ensure the service provided will be reimbursed. This process is crucial to avoid claims rejections and must be done as the first step to determine the service charges and patient’s responsibility also referred to as the patient’s share, and get any prior authorization if required.

While Insurance Eligibility Verification is a vital process that guarantees the service rendered will be covered, it is also considered a tedious task that takes a lot of time and effort. Recent research confirmed that the major reason for claim denials is the failure of verification of changes in insurance coverage. However, if you feel you have a loophole with your insurance verification process, it is ideal to outsource your insurance eligibility verification process to an experienced team. Let’s discuss why outsourcing insurance eligibility verification service is a good choice to make.

Benefits of outsourcing Insurance Eligibility Verification Process

Verifying insurance coverage eligibility of the patient is of paramount importance as any deviance or delinquency in this process might directly affect  cash flow of the practice. An outsourced team have the required knowledge, skillsets and will assist you with

Streamlining the process to save time and effort:

Outsourcing  Insurance Eligibility verification to an experienced team that has a streamlined workflow to handle every verification right from calling the insurance company to the documentation of the recent updates in the insurance policies, fastens your claims processing thereby minimizing unnecessary delays.

Minimize claims denials and delays:

An outsourcing company is adept with submitting cleaner claims. They are specialized in identifying erroneous data thereby reducing claims rework. An outsourced verification team keeps themselves updated with the regulatory policy changes, they are skilled in ascertaining prior authorization requirements, following up with the insurance company for any authorization issues and submit cleaner claims and increase revenue flow.

Enhance Reimbursement and Patient Satisfaction:

When you have access to the updated insurance eligibility information, it is easy for the practice to discuss the same with the patient and keep them informed in prior if the service will be covered under their policy or not.  Also, it increases the chances of submitting cleaner claims and getting them accepted and processed promptly and get reimbursed in due time.

Cost-Effective Service:

An outsourcing company provides the best quality insurance eligibility servicer at cost-effective pricing. An outsourcing medical billing Company has the futuristic infrastructure and reliable team to process your claims quickly and accurately at a competitive cost of service.

An Outsourcing team will provide the following insurance eligibility verification process to reduce denials and enhance your organization’s revenue flow.

• Scheduling Appointments
• Thorough verification of Insurance Eligibility and Benefit (coverage) details.
• Insurance and Patient follow up calls
• Obtain Prior-authorization/Pre-certifications
• Document verification details into the billing system
• Checking claims for missing or erroneous data and updating the same.

Using an offshore outsourcing partner for your insurance eligibility process entitles you with an unperturbed service, assuring faster Turnaround Time (TAT) with accurate claims processing ratio leading to increased revenue!

About e-care

E-care India is one of the top Offshore Medical Billing Companiesbased in Indiathat 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