One-Stop Solution For Revenue Cycle Management Services


Extending the Use of Insurance Verification to Outperform Your Competitors

Are you familiar with the game where kids sit around and whisper a sentence into each other’s ears, then the next person sitting down passes the information forward in a chain until finally, the last person shouts out loud which is very often funnily altered? This might make a good game. However, did you realize that eligibility and benefits verification will also put you in the same scenario, with a less presumed outcome?

Comparable to this, health insurance verification will involve the employer informing the patient about their health plan, followed by the patient providing the same information to you or the doctors they want to see then you can send this to the payer, It’s finally time for your final round for the last word to be announced. You’re out if the payers didn’t receive the correct information, as stated by the employers! You should stop playing the game. That sounds interesting. But when you’re experiencing it, it won’t be any good. Here is a lifeline for you to escape this situation, you can use eligibility and benefits verification services by verifying patient information in the first turn of their visit.

Here are the detailed procedures that are involved in the verification steps:

Obtain details on patients’ medical coverage

You shouldn’t ever count on the health insurance verification process to go smoothly; instead, give yourself plenty of room and time to complete it. Do request insurance information from new patients when they schedule their initial appointments. Simultaneously record the details of the same:

  • DOB of the patient and their name
  • Companies name (insurance company)
  • Insurance holders’ names and their relationship of them with patients
  • Policy number and identification number of patient
  • Contact details of the patient’s insurance company

Note: If the patient has multiple insurance plans, especially primary and secondary policies, you must wrap up all the necessary processes for each policy.

Be in touch with the insurance payer before patients visit

  • There is plenty of reason when asked why you start this process early, one includes is this particular second step. There will be times when you need to sit on the phone call for a minimum of half an hour, thus always it’s recommendable to initiate this call procedure to the payers at least three days before the patient visit, keep all the required docs In front of your desk before the patient visits.
  • Get in touch with your payers by telephone. Once you got the information accessible from the patient, your first move must be to find the insurance payers, by using the information just got and call them immediately.
  • Once you are connected with a representative from the other side make sure they are the same payers you were looking for. Now give them the same assurance by providing some information about the practice for ensuring HIPAA safety regulations. At last you are required to submit some information about the patients that are basic to locate the appropriate policy of theirs.
  • Try it on a different day or at a different time if you are having trouble reaching someone on the line. This situation is more analogous to other helplines where a large number of providers may call on a specific day or at a certain hour.

Browse online 

You can opt to check a payer’s eligibility digitally if you don’t like waiting on hold or long phone lines. But you need to surf through many websites and find forms for each payer which is also no lesser task than compared to telephonic communication. Look into your specific payer’s websites and find the answers to your doubts.

One shortcoming that wasn’t your fault but nevertheless caused you to make mistake is that these websites don’t always have the most up-to-date data on their websites, which confuses many.

Automation your next level game changer 

It is entirely acceptable at this time for you to move with automation services, if you have ever considered changing your working style or if bored with these lengthy calls and recordkeeping.

What you need to do is just spend some bucks from your pocket and you will get access to digital-driven eligibility checks that are done with just a outsource eligibility and benefits verification services with companies that provides healthcare rcm services.

Practolytics giving practices the ability to run real-time eligibility right from the PM/EMR system will help to streamline this process.

Questions to address before proceeding 

If you have all the necessary information, you can move on to the next round of verification. We understand the worth of every dollar, so why wait to double-check? Below is a list of questions that will allow you to collect all the necessary data from patients.

  1. Name your policyholder, the patient’s policy, and the group number
  2. What is your claims address?
  3. Is the policy date still ongoing and active, if so when it’s going to end?
  4. Leftover visits status of patients for this year for their therapy
  5. Do you have Patients co-pay, coinsurance data
  6. Are there any pre-auth requirements needed, or referrals that need
  7. Will there be any limitation in coverage of reimbursements, any requirement for additional documentation
  8. Is the physician in- or out-of-network to the policy

Also, we are having the responsibility to clear that this isn’t the only query that might come, still finding answers to this will give us a leg up.

The end destination 

Now that you had did this process without missing anything, you will be able to have a bunch of information that is accurate for your claims submission.

Your benefits checking is finished as of this point because you can record your information in the EMR. You can ring your patients to inform them of their projected co-pays in order to receive full reimbursement and avoid having them make last-minute demands.

 With that, you will be able to see your patient during their visit time, and do remember to get their insurance cards scanned and saved for your future reference.

Make more by keeping up with them frequently

This is an additional offer from us more like to get rid of issues that are uncommon but yet happen to many people. Very often patients change their insurance plans, and their reasons might change it can be due to birth or marital reasons, or a change in employment. Many will let you know about the changes, but some don’t, so you should check your health insurance verification periodically, perhaps once a month, to make sure you never miss this information.

Last thoughts

Luck can change at any time, there is no reason to always wait for it if you are working so hard. Blaming the luck element and failing to receive claims acceptance due to subpar verification procedures will never improve your practice.

It is widely acknowledged that practices already work day and night to provide the best service and never make concessions in exchange for payment. To take advantage of these real-time checking advantages, outsource eligibility and benefits verification services to Practolytics and contact us to learn more about our services.

prior authorization guide-practolytics

ALSO READActive Role of Eligibility Verification in Claims Approval