Your Ultimate Guide to Insurance Verification and Eligibility

How to implement office insurance verification for guaranteed payment?

Verifying insurance is necessary before you provide clinical services or DME products to a patient – this is an acknowledged fact. But what something significant is the accuracy of the insurance verification practices. Accuracy matters – because you want to make sure a few things during office insurance verification!

•  You want to know the kind of coverage the patient has.
• There are many different types of commercial providers. What type of commercial payer the patient is enrolled with. 
• The network affiliations of those commercial providers.
• You want to confirm whether the patient plan covers the specific diagnose, treatment or products.
• The insurance coverage is active.
• Other minute details to prepare your medical claim to get paid. 

As per a report, two out of five claims are denied by the payers due to eligibility errors. So, if you or your medical biller sends the medical claim to the wrong payer, the correct processing would delay. Additionally, the delayed claim resubmission to the right payer could result in the expired timely filing.  

Ask the Patient for Insurance Card

Have a look at the patient’s insurance card and find out the contact numbers mentioned. You need to call on these numbers. If needed, you can also call to the network the payer belongs to. By doing so, you can make sure that the payer is the same as you have the contract with. The followings are the points that you need to bring in the spotlight while you call the payer representative –

·         Insurance name, claims address, and phone number

·         Payer ID and group number

·         Name of insured person (as it isn't always the patient)

·         Relationship of the insured person to the patient

·         Effective date and End date of the policy

·         Whether insurance coverage is currently active or not

·         Whether the payer covers the procedure or services to be provided or not

·         Whether your healthcare practice participates with the plan or not

·         Whether a referral or pre-authorization certificate of medical necessity is required for reimbursement or not.

·         The amount of the patient's copay and deductible

Many of the payers also have the website that enrolled providers can access to acquire patient eligibility verification info.

Extra Care is needed to Record Insurance Information during office insurance verification

The information that you glean from payer portals or via calling is crucial to your payment success. These details can mean the difference between a paid claim and a denied claim. And obviously, you want your claim paid, at any cost! While your staff records the payer's details in the patient's EMR to determine eligibility, you can’t afford one single transposed number. So, pay extra attention to your eligibility practices.

Verify Insurance Online–Try Insurance Verification software by pVerify

Cut off as many as 50% of denials with a better, efficient and strategic verification practice. An online insurance verification tool, pVerify helps you with issues such as unpaid post-visit patient balances, Claim rejections due to patient eligibility errors, denials due to billing the wrong payer and staff expenses for verification and collection. Our application is guaranteed to maximize your collections and free up your office staff. Know more about pVerify here.