What Methods Can Be Used to Verify Patient Eligibility?

Verifying patient eligibility is one of the crucial steps for providers to ensure they are correctly paid for their healthcare services and no claim is rejected. There are several ways to accomplish patient eligibility verification accurately, depending on the efficiency of a practice’s process. 

Having an efficient patient eligibility verification process improves a practice’s revenue cycle, minimizes the risk of claim denials, and helps providers receive reimbursements on time.

This blog suggests the best practice solutions to verify patient eligibility so that healthcare providers get all the claims hassle-free and fast.

Make patient eligibility verification more efficient with the best solutions

Verify patient eligibility in real-time

Real-time patient eligibility verification can save a lot of your practice’s time. This allows medical providers to be informed about the patient’s coverage details before the treatment. Verifying a patient’s eligibility in real-time enables providers to record the data about their insurance coverage, copays, and deductibles in EHR and prevent claim denials.

Visiting Insurance Websites

One of the simplest ways to verify a patient’s insurance eligibility is to directly visit the insurance provider’s website. Many insurance companies allow providers to check a patient’s eligibility, insurance coverage details, and benefits. You just need to enter some required information, such as the patient’s name, date of birth, and insurance ID, to check eligibility. Remember, to access the insurance company’s website or services, you may need to enroll or register first with a plan.

Via a Clearinghouse

A clearinghouse allows providers to fetch information from more than one payer in one place and prevent it from operating in multiple portals or websites. It provides an eligibility verification tool using which providers can give detailed insights into coverage details and all the other information required to verify patient eligibility. However, this process typically takes time.

EHR Integration

It is no surprise that most healthcare practices use EHR for clinical documentation. Patient eligibility verification can be also done using an EHR system. In-house medical staff can send the patient’s insurance plan information to the carrier and verify eligibility in real-time from Medicare, Medicaid, and many other insurance carriers.

Through Your Practice’s Software 

Many practice management systems enable providers to check a patient’s eligibility before their appointment and help them generate an eligibility check promptly. Some practice management systems provide a detailed verification of eligibility so that providers can give coverage and copay information to their patients instantly.

Call the Insurance Providers

Calling the payer directly to verify a patient’s eligibility is a traditional approach and can consume a lot of the provider’s time. The waiting time can be long, and you may have to go through multiple interactions and follow-ups to verify eligibility for each patient. This method is not preferred by most providers today. 

Outsource Eligibility Verification

Taking professional assistance from industry-leading experts can be a smart choice. When you outsource your practice’s patient eligibility verification process, you have skilled professionals to carry out the task for you more efficiently and seamlessly. Each stage of the eligibility verification process is executed with the highest accuracy, resulting in near-zero claim denials, timely payment for the services rendered, and increased practice efficiency.

Capline Healthcare Management is one of the leading healthcare management companies in the United States that offers the best-in-class patient eligibility verification services for providers. Capline’s streamlined eligibility patient verification process can eliminate simple errors that can lead to delays in reimbursements and impact practice revenue. With Capline,  verifying patient eligibility in advance, providers can be ascertained that they are paid correctly by the patients or insurance carriers for their treatments.