- Patient insurance eligibility verification is the first—and perhaps most critical—step in the billing process. Physicians need to verify each patient’s eligibility and benefits to ensure they will receive payment for services rendered. The process of verifying patient eligibility and benefits can be a time-consuming process for clinics and hospitals, no matter how many patients there may be.
- The process of obtaining the insurance eligibility verification of a patient is necessary to ensure that the patient has coverage, services that are being provided are covered, denials and appeals can be minimized and payments are expedited at the appropriate rates. Denied claims due to no active coverage, out of network, unauthorized patient procedures or visits can be a major loss in revenue and should not be taken lightly.
- Before the patient’s visit to the provider, we perform pre-insurance verification to check eligibility regarding the particular insurance, whether any co-payment has to be collected, and whether the patient’s insurance covers the service sought from the provider. We also check the requirement for any pre-authorization or referral, and if the patient has met the deductible, the amount of co-insurance the patient shares.