Why is Insurance Verification Important

Health care industry endeavors to provide medical care to every individual despite the lack of financial aid. Therefore, a lot of hospitals have joined hands with insurance companies to offer health care insurance to those people who can’t afford basic medical care. But insurance claims can easily be manipulated leading to denial or fraud. This makes it necessary for hospitals to verify claims of the insurance to be able to get payment for the medical resources spent on the patients.

The following are the reasons why insurance verification is important:

Identification of True Claims

The health care industry encounters thousands of patients claiming to have health care insurance. However, not all of these patients succeed in submitting correct documents for their insurance claim. Insurance verification helps in identifying whether or not the insurance claim made by the patient stands true. The verification process is considered to be over only after the hospital has cross-checked the information given by the patient. For this purpose, the hospital is required to contact the insurance provider and get the information cross-checked. In other words, verification helps in establishing the eligibility of the patient for the insurance claim. Furthermore, it also helps in identifying the coverage status and active/inactive status of the claim.

Preventing Denials and Fraud

Insurance claims are required to be authorized by the insurance company. Without authorization, the payer is not obliged to make any payment. So, if you go to the insurance payer claiming to have insurance without any authorization then you won’t get the payment. In addition to this, not to forget, the EOB along with the insurance claim may also lead to denial of the insurance. In such cases, insurance verification helps in preventing denied claims as the verification process demands to review the submitted documents. Moreover, verification also helps in preventing fraud by eliminating false insurance claims.

Maximum Reimbursement, Strong Revenue Cycle

Insurance verification ensures reimbursement of maximum insurance claims by getting them authorized, eliminating fraud and preventing all the denied claims. This means hospitals and doctors get paid for the medical insurance verification services they have provided to the patients having insurance claims. The uninterrupted cash inflow ensures that the hospital can invest in different medical specialties by getting new medical equipment and expanding inpatient/outpatient facilities to improve the quality of medical care.