Insurance Verification Checklist

Hospitals rely on medical billing companies for better insurance verification services. It is because insurance verification needs a good knowledge of insurance plans, insurance companies, and compliances applicable to a particular hospital located in a particular state. However, even the insurance specialist needs to have a checklist for the insurance verification process. So that he/she doesn’t overlook the verification of necessary information. Being a responsible verification specialist one needs to make sure that every detail related to the insurance claim is covered in the verification process. Not verifying the insurance claim thoroughly may result in denied claims or even fraud. Therefore, must make a list of all the details/documents are required to be verified for a true claim for maximum reimbursement.

So, the following is the medical insurance verification services checklist to help you with the verification process.

• Personal details of the insured patient or individual—name, date of birth, address, phone number, etc
• Patient’s insurance card number and group number
• Insurance plan or insurance name
• Details of the insurance provider—name, claims address/billing address and phone number
• Status of coverage—active or inactive
• The effective date of the policy
• The end date of the policy
• Explanation of benefits
• Details of coverage of the insurance plan—diagnosis, procedure, services, benefits, etc
• Limitations of policy—exclusions/bill documentation requirements
• Pre-authorization certificate
• The requirement of referral proving medical necessity
• Copay and deductible amount

While verifying the above details/documents the insurance verification specialist must follow some tips to avoid any error.

The following are tips to prevent errors or mistakes in the verification process.

Divide the insurance details provided by the patient in four categories.

• Demographic details of the patient
• Insurance plan
• Benefits verification
• Patient Communication

Dividing the details into the above-mentioned categories will allow you to perform the verification process in a more streamlined manner. It will also allow you to catch any discrepancy of missing information easily.

• Double-check the insurance claim details provided by the patient. It is better to contact the provider and cross-check the provided information.
• Make sure to check the procedure or medical care service covered in all the insurance plans. This will give you a better understanding of the benefits covered in the insurance claim.