What is Insurance Verification Process

Insurance verification is a complicated process that is directly related to the reimbursement of insurance claims made by many patients. The process consists of the following steps for successful verification of claims and reimbursement.

Patient Scheduling/Registration

When a patient arrives at the hospital he/she is required to make an appointment with the doctor. This process is referred to as patient scheduling or registration. The registration can be by opting for self-scheduling. The patient receives confirmation via email or phone texts. Self-scheduling helps in making the process quick and streamlined. In case of emergencies, the registration can be done at the hospital itself.

Patient Enrolment

Demographic data is essential in insurance claims for it helps in identifying the patient. The demographic data may include details related to patient identification and medical history. The details like name date of birth, address, phone number, and email ID fall under patient identification. Whereas details like previous health issues, diagnoses and /treatments may fall under medical history. Moreover, additional information like emergency contact details, father’s name, insurance provider, etc. may also be recorded.

Eligibility and Verification

Insurance claims come with a risk of fraud. A lot of patients tend to make false insurance claims. Therefore, patient enrolment is not enough to prevent any fraud. As precaution hospitals must cross-check the insurance claims details provided by the patient. The purpose of hiring a medical insurance verification company is to check the patient’s eligibility for the insurance claim.

Authorization

Insurance verification only establishes the eligibility of a patient’s insurance claim. But it does not ensure that the insurance provider is obliged to pay the amount. This is where authorization steps in. It binds the insurance payer to authorize the claim by signing a document as a promise to pay a certain amount. This step is essential in avoiding denied claims and should not be overlooked.

Updating Patient

Hospitals must update the patient in case of any changes or discrepancies that may appear while verifying the insurance claim.

Updating Medical Billing System

Hospitals must update the billing system to make correct charge entries for payment purposes.

Claims transmission

This is the last step in insurance verification. It includes submitting claims submission requests. The request may be made electronically to make the reimbursement process hassle-free.