How to make the most out of your Insurance Eligibility Verification process?

In healthcare, insurance eligibility verification and its efficiency are pivotal to growth. Today, claim denials have gone up even when the practices struggle to make a robust financial base. A claim can get denied on multiple grounds, and practices need to be experienced enough to minimize the same.

A robust and efficient practice must have a strong patient eligibility verification system. That is how you as a provider can cope with today’s challenges, reduce the denials and boost the overall revenue cycle. 

Practices must ensure that each patient’s insurance details are thoroughly vetted and verified before the appointment. It helps avoid confusion and keeps the reimbursements coming. In addition, any hiccup that is identified in the initial stages of insurance verification can be worked out.

Claim Denials and common denial grounds

There is more than one reason that claims are denied. Some of the most common reasons include:

• Terminated or expired insurance policy
• Coordination of benefits not updated
• Non-covered services
• Benefits exhaustion 
• Plan limit reached
• Missing pre-authorization or referral
• Incorrect patient information
• Incomplete policy details
• Missing or inaccurate mandatory information

Besides these reasons, there can be other possible scenarios too. However, If you want to avoid denials for the reasons mentioned above, your practice needs a thorough verification process. 

Steps to an efficient medical insurance verification

1. Collection of the insurance card

That is where the entire process starts. Your practice must initiate the insurance verification process by collecting the insurance card from the patient or the existing records. An insurance card is a primary document that decides the fate of what is about to come. Even if a patient has submitted a copy of their insurance card before, asking for an updated latest version is safer. 

2. Follow the checklist

Once you have collected the copy, all the relevant information needs to be captured. Any mismatch can end up with a denial. Here is a data checklist that you need to capture:

• Patient Name
• Primary Insured Person’s name
• Insurance providers name
• Insurance number
• Group ID Number
• Whether the practice of the provider is enrolled with the payor
• Policy period
• Policy coverage
• Copay and deductibles details
• Policy service coverage
• Preauthorization details for treatments, specific procedures, and medical services

3. Contact the insurance provider.

When you have all the details, it is an excellent practice to call the payor and verify the captured details. If there is any mismatch, now is an excellent time to identify and correct the same. The electronic download option makes it easy to download the data faster.

4. Record complete and accurate information

Ensure that your team collects all the necessary information about the insurance from the insurance provider and patient. Be extra cautious while recording any information related to patients or their claims. One minor error can cause a denial. This step is the most crucial milestone, and staff should be extra vigilant in handling this.

5. Connect with the patient- whenever required

If you need some clarifications or have any questions during the verification process, you should not hesitate to contact the patient and seek clarification. Clear communication with patients is always a priority and should be followed through. The patient has to be notified of information related to deductibles, copay, coverage shortage, etc. It will help accelerate the collection timeline and avoid any last-minute surprises. 

Get in touch with Capline Healthcare Management.

Eligibility verification is crucial for a healthy revenue cycle. However, your practice needs a strong backend partner for minimum denials and faster claims to help you minimize the hassle and increase reimbursements. 

Capline Healthcare Management is a leading eligibility verification service provider in the United States. We have collectively helped more than 400 practices grow with an impressive number. Connect now to know more.