Eligibility and Benefits Verification for Your Practice
Eligibility and Benefits Verification
Eligibility and benefits verification can be complex, with patients taking on more payment responsibility and frequently changing insurance providers. You need to identify coverage fast and reduce the number of claims being denied on the back end due to inactive insurance or non-coverage. There are many things that can influence the patient’s responsibility, such as whether or not the provider is in-network, if the patient has a deductible, and the type of provider providing the service. When patients and providers are aware of their coverage, co-pays, and deductibles at the time of service, you experience fewer payment delays, less confusion, and minimal need for follow-up.
Generally, when a new or returning patient comes to a medical provider, they bring along their insurance identification card. The person responsible for checking them in should then check with the insurance carrier to ensure that the information on the card is up-to-date and correct. This can often be accomplished by checking the website of the insurance carrier or calling a representative of the insurance carrier. Some practice management systems and clearinghouses are also capable of checking patient eligibility.
Verifying Patient Insurance
Collect the patient’s insurance information. When you collect the patient’s insurance information, be sure you record:
- the name of the insurance company,
- the name of the primary insurance plan holder and his or her relationship to the patient,
- the patient’s policy number and group ID number (if applicable), and
- the insurance company’s phone number and address.
- the patient’s name and date of birth,
Or simply ask for insurance (front and back) and a driving license copy, you can get all the required details. Also, upload an insurance scanned copy (front and back) and ID in your billing software for future reference. If the patient has secondary insurance, get those details also and verify secondary insurance information also.
Use Provider Portals
Create a provider account for every insurance company you are charging. Creating a provider portal is really easy and hardly takes few minutes to set up. You will need basic practice information like TIN, billing NPI, email ID, and other contact details. You can also create an account on Availity, which covers a lot of insurance companies. After your provider account is set, simply put new patient information like member ID, last name, first name, DOB, and with a single click, all eligibility and benefits information will be available. If required you can print it and attach it to the patient file.
Contact by Phone
The most common way to contact payers is over the phone. Just pull up the info you got from your patient, find the insurance carrier’s phone number, and dial away. While talking with an insurance representative you’ll have to provide some information about your practice to confirm that this is a HIPAA-secure exchange. Finally, the rep will ask you to provide some of the patient’s information (usually the patient’s name, date of birth, and the policy number) so he or she can locate the correct policy. Calling and confirming eligibility and benefits over the phone could be time-consuming.
When gathering all this information prior to treating the patient is done correctly, your office will see a much-improved reimbursement for the services rendered. E2E Medical Billing Services offer comprehensive patient eligibility verification services to help healthcare providers check coverage prior to the office visit. Our team will verify demographic data, benefits i.e., co-pays and co-insurance, coverage, and prior authorization requirements. To know more about our benefits and eligibility verification services contact us at 888-552-1290 / info@e2eMedicalBilling.com