Insurance Verification for Dummies

The process of insurance verification plays an important role in the health care industry. It is because insurance claims made by thousands of patients carry a huge risk of denied claims or fraud. Sometimes patients tend to make false insurance claims that are likely to affect the revenue cycle of hospitals. However, not every individual is aware of the complexity of the process and its importance in medical practice. Therefore, everyone must understand the process of insurance verification and its role in providing medical care to thousands of patients while getting maximum reimbursement. The following are the steps involved in insurance verification to help individuals comprehend the idea of verifying claims.

Patient Scheduling

The process of insurance verification begins with patient scheduling. It involves gathering data that is relevant to schedule a patient’s appointment. Patient scheduling may be done via phone text, fax or email. The facility of self-scheduling is available with a lot of hospitals. Scheduling helps in making the process more streamlined by reducing the number of people standing in long queues to get an appointment at the hospital’s reception.

Patient Record

This involves gathering a patient’s demographic information and medical history to maintain a proper record of medical issues, its diagnosis, and the treatment. Recording the patient’s demographic and medical data is quite essential in the verification process.

Eligibility and Verification

The medical insurance verification company verifies the insurance claims made by the patients. It is where the data in the patient record becomes quite useful. The patient record helps the insurance verification specialist to identify the patient, cross-check his/her insurance claim with the insurance provider. The verification specialist verifies the details like the patient’s name, date of birth, insurance ID, etc.

Authorization

Once the claim has been verified the insurance verification specialist ensures to authorize the claim. This obliges the insurance provider to pay the promised amount without any failure.

Contacting the Patients

The verification specialist is required to follow up with the patients to update them about the progress made in insurance claim verification.

Updating Medical Billing System

This helps in keeping track of payment details to make claims submission successful and error-free.

Claims Transmission

It refers to the process of filing insurance claims either electronically or manually.