Efficient ways to check insurance eligibility verification steps for every practice

As per industry sources, close to 70% of all claim denials are insurance-coverage related. A large number of claims get denied or delayed for insurance-related details such as insurance was not active during the procedure period, the particular medical service or procedure was not covered by the insurance plan, and so on.

A strong, effective insurance eligibility verification process can restrict these challenges, reduce denials, and improve the overall revenue cycle.

It is always better to make sure that the insurance details are verified thoroughly before and the medical services are initiated so that there is no confusion or challenge after the treatment is provided. Because of this, hiccups can be identified and sorted out at the initial stages.

Ineffective dental insurance verification: Top denial reason

• Policy not active or expired
• Medical services not covered
• Typo errors
• Missed mandatory information
• Incorrect or incomplete patient information
• Incorrect or incomplete insurance policy details

There could be other scenarios too. To avoid claim denials arising primarily out of insurance eligibility checks, a detailed verification process is a mandate.

Steps to strengthen the entire verification process and reduce claim denials

The following are the top steps known to strengthen the entire insurance eligibility verification.

 1. Make sure to collect a copy of the insurance card the patient

Make sure to initiate the insurance eligibility verification process by collecting the insurance card of the patient to file in records and for further process. This turns into the primary document for the verification.

Even if the patient has submitted a copy during the earlier services, collecting a copy again would help to check for any changes or even to check the basic expiry.

2. Keep a note of the insurance eligibility verification checklist

Once the copy is collected, all the information listed in the below checklist should be recorded in the patient’s records. Any confusion would wind up in medical bill denial.

Checklist includes:

• Patient name, contact details
• Primary Insured person’s name (If the primary insured person is not the same as the patient)
• Insurance provider’s name, contact details, and address
• Insurance number and Group ID number
• Whether the medical practice and the physician are enrolled with the insurance provider
• Policy period (Date of start and end of the policy)
• Policy coverage cost and the total amount used so far
• Details of policy service coverage (Medical Services included in the coverage)
• Co-pay and deductible details
• Pre-authorization subtleties for explicit procedures, treatments, and medical services
• Some other explicit necessities of the plan for claims and limitations

3. Connect with the insurance provider

After collecting all the details, it is always better to call up the insurance provider and verify all the policy details from them and confirm all details

Any mismatch can be easily identified at this stage and rectified. With the electronic download option available now, all data can be downloaded easily which makes the process faster and easier.

4. Collect and record the complete and appropriate information

Make sure the team collects all relevant information required with regards to the insurance from the patient and the insurance provider.

The team should also be doubly careful while recording all the information about the patient and their claims.

Any minor error can also lead to denial and will delay the claim process. This step forms the base for the entire claim process and the team handling should be extra vigilant.