Insurance Eligibility Verification Process in Physician Practices

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Insurance Eligibility Verification Process in Physician Practices

Insurance eligibility verification is the process that involves checking the active coverage of the patients and related details with the insurance company.

[Year] Outsource Strategies International 8596 E. 101st Street, Suite H Tulsa, OK 74133

http://www.outsourcestrategies.com/[Type text][Type text]

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Insurance eligibility verification is a crucial step in the patient registration process in physician practices and a critical element in the practice’s revenue cycle management. Lack of accurate and timely verification can result in denied and delayed payment.

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verification process must be done before the patient is provided the required services.

For a new patient, the front office staff should take the insurance information and verify with the insurance carrier, electronically or by phone to make sure that the patient is an active member of the insurance plan and check whether any special documentation is necessary for this patient such as prior authorization or referral. Insurance information collected should include the name of the insurance company, claims address, phone number, policy number, policy effective dates and type of policy. For instance, in dental medical billing, the sources of eligibility information start with the dental plan ID card, enrollee ID number, and date of birth of the patient.

In the case of accounts that cannot be verified, staff should contact the patient and request coverage details. For unavailable coverage, patients should be informed about their responsibility to pay for the services during the appointment. The appointment may be rescheduled for interested patients.

As each patient is checked out after the office visit, make sure to collect the encounter form that has details regarding the patient’s office visit, billing information and the release of information signed by the patient. They should also collect any co-pay that is due from the patient, and provide them with a receipt. The receipt should outline the services provided and the costs so that the patient can verify his/her own health insurance.

Step-by-Step Process Medical Billing and Coding Companies Follow The insurance verification process includes verification of payable benefits, patient details, pre-authorization number, co-pays, co-insurance details, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, claims mailing address, referrals & pre-authorizations, life time maximum and more. Well-organized procedures for collecting patient information and verifying insurance eligibility will facilitate a streamlined claims and medical billing process. A medical billing and coding company follows customized insurance verification and authorization process that involves –

www.outsourcestrategies.com

Phone: 1-800-670-2809

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Patient registration and schedule - Receiving patient schedules from the physician office via fax, FTP or email

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Patient enrollment – Adding or updating demographic information and prior authorizations for patient visits

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Benefit verification - Verification of coverage on all primary and secondary payers

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Authorization – Getting authorization for medical treatment for appropriate sources

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Patient communication - Contacting the patient if additional information is needed

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Billing system update – Updating the billing system with all the verification details

Outsourced insurance authorization and verification services help physicians to benefit from - reduced rejections/denials of claims, more time for patient care, improved productivity, greater patient satisfaction, more clean claims and improved efficiency in the facility. Expert insurance verification services will assist the practices to review the health insurer’s contract to determine their rules regarding pre-authorization, pre-certification and/or predetermination.

www.outsourcestrategies.com

Phone: 1-800-670-2809