Insurance Verification Process

While outsourcing insurance verification services from a medical billing company one must ask the following questions.

What is insurance verification?

As the term suggests insurance verification refers to the process of verifying insurance claims made by patients claiming to have medical care insurance.

What are the steps involved in the insurance verification process?

The following are the steps involved in the insurance verification process.

• Patient Registration: The step in the insurance verification process is to register a patient with the hospital by creating his/her patient ID. This is done by scheduling a patient’s appointment via email, fax, phone texts, etc. Some hospitals also provide the option of self-scheduling through online appointment booking.
• Patient Enrolment: This step is essential to gather the patient’s demographic data and medical history. Demographic details may include name, date of birth, address, phone number, and email id. The medical history focuses on health issues and diagnoses. Information like father’s name, emergency contact, insurance company/provider, etc is filled under additional details.
  Eligibility and Verification: It requires the insurance specialist to contact the insurance payer to cross-check the insurance details given by the patient.
• Authorization: It is a kind of legal obligation that is necessary to get the approval of the insurance payer to perform a procedure confirming that he/she will pay the promised amount.
• Contacting Patient: Maintaining contact with the patient is important to share any new information.
• Updating Medical Billing System: This step is imperative to maintain the record of correct payment details.
• Claims transmission: It simply refers to the process of submitting insurance claims either manually or electronically.

What are the advantages of insurance verification?

The following are the advantages of outsourcing insurance verification services.

Decrease in Denied Claims and Prevention of Fraud: Medical Insurance Verification Company identifies whether the insurance claims made by patients are true or false. Rejecting false claims prevents the hospital from falling into the trap of denied claims or fraud.

Maximum Reimbursement: Verifying the insurance claims and getting them pre-approved is one way to ensure that the doctor will get paid for the procedure he/she performs.

Improvement in the Quality of Medical Care: Maximum reimbursement of claims will allow the hospital to invest in in-patient and out-patient, medical equipment, emergency medicine, and other medical facilities like labs, etc.