Insurance Eligibility Verification Services

One of the first and most important phases in the medical billing and coding process is verifying insurance eligibility. When patients provide inaccurate or incomplete information about their insurance coverage during visits or when the hospital or administrative staff fails to update the current coverage information, the majority of medical claims are delayed or refused by insurance companies. As a result, the company's cash flow is negatively impacted by the delay in reimbursements. Delays and denials of insurance claims can be avoided by outsourcing this to a company that has a skilled group of medical billing and coding specialists that stay current with all the ongoing changes to health plans and policies.

Medical Insurance Eligibility Verification Services

We have worked with several clients all over the world throughout our more than ten years in the medical billing and coding industry. We make sure that our services are precise since we recognise how crucial it is for an insurance provider to accurately verify medical insurance claims. Our product line includes:

Insurance Denial Appeal

With a committed team of data professionals, our company, one of the trustworthy insurance verification firms, validates accounts receivable and insurance claims to ensure maximum payouts. To determine if the procedure is medically essential, we also keep track of the co-pay information and seek for diagnostic information. Additionally, every refused health insurance claim is immediately appealed in an effort to overturn the decision and receive full payment.

Business Improvement

The goal is to streamline the invoicing and verification process as one of the most reputable insurance verification services firms. In order to fix the issue at its root, our professionals work precisely and spot problems with the data. We make care to satisfy customers, match market demands, and provide quicker response times. Additionally, our insurance verification services help our clients optimise efficiency and produce accurate claims.

Verifying Patient Insurance Coverage

A day before to the scheduled patient visit, we confirm the patient's insurance E&B and insurance coverage data with the primary and secondary payers by either getting in touch with them personally or by visiting their official online insurance portals. Co-pay, deductible, co-insurance, in-network and out-of-network benefits, and PCP name matching are then recorded and updated in the patient notes.

Checking Documents

When we receive the documents from the insurance companies or healthcare organisations, we carefully review each one and compare it to the list of required documents. Using this method, we can arrange the documents in the way that the insurance provider requires.

Patient Follow-up

As part of our service procedure check, we immediately get in touch with the patient if necessary to ask for any missing or wrong information and obtain the necessary authorization. Before making the final submission, this aids in keeping track of all the information and cross-verifying this information.

Final Submission

The final findings, which contain the patient's eligibility and benefits along with other specifics like group ID, member ID, start and end dates of the insurance coverage, copay information, etc., are delivered to the client.

We make Insurance Verfication Services Excellent by:

Verify the patient's information, including payable benefits, deductibles, the mailing address for claims, the patient's insurance status, and plan exclusions.

Obtain the pre-certification number, get the permission request approved, and coordinate with the customer for more information.

Check that patients are covered by all primary and secondary payers, and promptly update their accounts.

Maintain the highest standards of correctness and stay in touch with the client until the paperwork is finished.

Check the mailing addresses for the co-pays, co-insurances, deductibles, and claims to ensure a smooth process.

Our Insurance Eligibility Process

  • 1. Receive Payment Schedule

    Beginning with the patient's admission for medical treatment, we verify their insurance eligibility.

  • 2. Verify Insurance Coverage

    In this phase, we check patients' eligibility requirements and insurance coverage to see if they are eligible.

  • 3. Auditing & Contacting

    Prior to submission, check for mistakes and inconsistencies. To get their consent for the authorisation request, we get in touch with the insurance companies.

  • 4. Collection and Updation

    Follow-up on patient accounts is done in-depth to ensure that claims reimbursements, appeals, or any missing billing information are received.

Why We are Supreme in Insurance Eligibility Verification in Industry ?

Entire Compliance

We serve a specific market by following stringent documentation guidelines to be HIPAA compliant.

Secure Data Assurance

Our transmission and communication methods include VPNs, SSLs, and encryption mechanisms, and we make sure to use firewalls.

Extensive Training

To help the team become familiar with new technology and stay current, we often conduct training.

Strict Claim Audits

We undertake regular audits of insurance protocols to analyse the type of errors, so as to not repeat them, thereby streamlining the insurance verification process

High Accuracy

Our knowledge of billing and insurance verification services aids customers in accelerating revenue cycle management for speedy claims processing.

Superior Tools

To cut costs, produce new leads, and improve the accuracy and diligence of our service, we choose cutting-edge technology.

Benefits of Choosing Us

  • Eliminate the need for tiresome in-house patient verification processes
  • Claim coverage at any stage of billing process.
  • Avoid claim processing errors with upfront accuracy
  • Improve insurance eligibility rates and reduces claim denials
  • Remove the need of expensive re-work, manual processes, and phone calls to payers
  • Minimize billing and collections costs, bad debts, and time in Accounts Receivable.
  • Improved cash collection and patient satisfaction
  • Improve overall staff efficiency
  • Minimum 30-40% saving on operational costs

Benefits of Outsourcing Insurance Verification Services?

Verifying insurance eligibility can be a laborious and time-consuming process. It can result in expensive claim denials, longer A/R days, and delayed payouts if done incorrectly. Poor insurance eligibility verification procedures can necessitate the re-submission and revision of claims. In the end, this means that healthcare providers would experience decreased cash flow and suffer significant losses as a result of patients who are unable to pay for their medical expenses.You can get a lot of advantages by outsourcing your insurance eligibility verification needs to an insurance verification firm. A few of these are:

Focus on Core Competencies

You may concentrate on your key abilities with the aid of insurance verification businesses. This is so you may concentrate on providing high-quality medical care rather than worrying about paperwork by outsourcing to them. Your front office employees won’t even need to follow up with patients or insurance providers to gather the information needed to update your system for successful medical billing. Allowing the professionals to handle insurance eligibility verification frees you up to focus more on the patients, which is what you are most knowledgeable about.

Reduce Risk Factors

You can lower the risk variables that could negatively impact your practise by outsourcing insurance eligibility verification services to the professionals. This is because putting in place an effective verification method can safeguard your financial position. You can relax knowing that every patient in the system has been verified and their insurance coverage has been verified, preventing you from having your claims denied or suffering significant losses due to non-payment at the end of the day. As a healthcare provider, you may be sure that you’ll always get paid on schedule if you put insurance verification first. Denial management will no longer be an issue for your practise in this method.

Fewer Claims Rejections

You work with experts in their industry when you outsource insurance eligibility verification services to third-party service providers. These skilled experts are aware of the warning signs to watch out for while determining whether you have active coverage or not. They will be aware, for instance, if you have coverage but a particular medical procedure is not covered by your insurance plan.

Streamline Business Operations

By handing over control of the necessary steps to the professionals, who will standardise them into specific processes, the cycle will be completed in a set amount of time each and every time. In essence, this indicates that your company’s operations and procedures have been streamlined to ultimately save time and effort. This process standardisation will lead to greater efficiencies, which will enable you to use fewer resources overall.

Accelerated Billing Cycles

You can speed up your billing processes by giving outsourcing partners responsibility for determining insurance eligibility. The professionals will be aware of the pertinent questions to ask, the data that requires confirmation, and the medical services that might not be covered by the plan. Billing cycles will undoubtedly be sped up as a result of the effective collection of these data and the reduced need for follow-up with patients and insurance companies.

Reduced Claims Reworking

Additionally, they make sure they have all the necessary insurance data and that everything was done correctly the first time. There is no place for rework if your resources are capable of completing things correctly the first time. With claims no longer experiencing delays or requiring resubmissions, denial management will also no longer be a major worry for your practise.

Improved Cash Flow

For healthcare providers, the RCM process is rife with thousands of inefficiencies and error-prone points. If these mistakes are not fixed right away, they could reduce your revenue. Verifying insurance eligibility is a crucial initial step in the RCM process because it may make or break your practise. You might as well give up if amateurs or new hires are trusted with the intricate process of determining insurance eligibility. This is due to the influx of losses and claim denials that may affect your company.

Identify Core Reasons for Unpaid Claims

These professionals can pinpoint the primary causes of your unpaid claims. This is due to the fact that pattern recognition indicates that they are sufficiently experienced with your procedures to identify which task or stage of the procedure is responsible for the majority of claim denials. You can then put up procedures to stop claims denials from happening and generate more income by identifying the primary reason for your underpaid claims.

Cut Operational Costs

One surefire strategy to save operational costs is to outsource insurance eligibility verification services. This is because processing your patient’s insurance coverage uses less resources. Increased inefficiencies occur from hiring more front office workers to handle higher business volumes because new hires must undergo extensive training before they can contribute to your practise.