Eligibility Verification & Pre-Authorization, Proactive Prevention of Delayed/Denied Payments
Real-time prior eligibility and authorization checks, speed-to-care, and improved revenue collection.
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Insurance eligibility verification and pre-authorization
Is the single most important step in speeding up claim submission, faster reimbursements, and reducing the chances of denial in the medical billing process. It is the revision process of an insurance claim to verify that the patient is eligible for the service being billed and authorized to receive this benefit under the policy of their insurance benefits.
Reduce denials rate by 40%
Prior to arriving at the scheduled appointment, billing staff should properly capture information and confirm whether any of the patient’s active insurance plans cover the benefits listed and if authorization is required in advance of delivering the requested services.
This process can save 40% on potentially lost profits in denied/delayed payments and informs patients of their payment responsibilities upfront, which increases patient satisfaction rates.
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Patient Information
Obtain demographic information from the patient or the referral source and create an account for each patient.
Coverage and Authorization Verification
Check that benefits are covered by the patient’s primary or secondary care payers for the appointed date and time of care delivery. Verify their insurance plan, plan exclusions, policy status, coverage period and patient specifics, type of plan, effective date, lifetime value, and other applicable data.
Confirm Data
Promptly confirm the information received from the patient and payer. Identify and resolve any missing or invalid data before claim submission.
Benefit Authorization
Obtain prior authorization approval if required for the requested treatment.
Payment Determination
Determine patient payment deductibles, co-payments, co-insurance, payable benefits amounts, and payer payment responsibilities. Inform the patient in advance of the required payments to be collected before or after they receive the treatment through online or cash payment.
Documents Submission
Prepare and submit all the required documentation required by the payer to support the reimbursement of treatments and services delivered to the patient by direct phone contact, web portal, or online.
