All Eligibility and Benefits Verifications

Answers to Frequently Asked Queries About Eligibility Verification

When you take your car out to go to an old friend’s house will you go straightaway? But what many prefer is to make a call and ask them if they are still in the same place. Confirmations are always satisfying when you’re doing a task, the hope that your friend is still there, and the advantage that you don’t waste time by traveling in the wrong way. Confirmations are always crucial to take a big task at your hand.

This advantage is what we will be obtaining with health insurance verification. Confusing? Don’t worry eligibility and benefits verification services in simple words it is all about the confirmation that practices get about their insurance coverage, plan, copay, and deductible details of each patient.

The main aid that we get from health insurance verification, is that providers can get accurate information about patients’ insurance coverage well before the appointment date and thus can have a plan for collection and also frame monthly revenue outcomes well before.

To prevent delays you must prioritize eligibility verification that conjointly reduces claims rejection. To do this one measure you can consider in your practice is, having a clear idea of how the process works.to understand it read through this article that gives answers to your most common doubts.

Table of Contents

Ways to check eligibility

Eligibility and benefits verification services, as its name checks eligibility and benefits which serves a dual role for us can be done in dual ways. One way to do this is by manual checking and the other is by electronic checkup, which is done within a couple of days before the patient’s appointment. In this ever-changing and fast-running world it’s of course recommendable to use electronic checks in health insurance verification.

By this, you can get,

Information about your patient’s insurance and benefits status before their visits.
Get advice from your patients about their pending copays, and if it is there receive the same without any delay.
Verify the insurance policy and check the updated one if it covers the policy.
Get information about your patient’s primary care physician, and next to that get details about (COB) coordination of benefits which applies when they are having two or more policies.

Information that we can get from eligibility verification

For all this time we have been constantly telling you about the information that you might get from the eligibility and benefits verification services, but what exactly will you get is what your next query, isn’t it? Eligibility coverage tells about the following resources to you.

These resources mainly comprise the patient’s personal details which may include the patient’s name, date of birth, gender, patient’s membership number, policy type of their insurance, and the insurance coverage date. In addition to that, you will be receiving information about subscribers’ name and their relationships with the patient that is the one who is earning and have a relationship with patients.

This doesn’t end there, in addition to these basic details payers also send additional details to you prior, which explain to you the difficulties and complexities that persist within your patient’s insurance type and give other resources to you that are included in it.

The right moment to verify eligibility

When to start the eligibility check? Are you facing delays? Have you ever been beaten by a teacher for late submissions? So being late is not acceptable, then you must know how exactly it’s important to keep up with time in eligibility checks.

The right time to do this is before your patient visit, preferably a couple of days before which helps in giving information at the right time. This procedure can also be performed manually or during their in-visits by your administrative staff but can you attain the benefit? To do this your staff should not forget if there is an update that is included in your insurance.

One extra tip from our side is that if you still go for in-desk checking then do collect a copy of insurance cards which will be useful in backend verifications in the latter cases.

Walk through the steps in Eligibility verification practices

Checklist of details that needed to be verified during this course of procedure:

The foremost step you should consider is finding the plans that are not active, which will lead to the denial desk, and making a mark of the same.
Next to that is the number, i.e., the number of insurance plans that the patients are involved with. A patient might have one primary and a secondary plan, so it’s their responsibility to give details about the same. Next comes into the field is the (COB) coordination of benefits, which will give you details about the split in the insurance coverage of each payer.
Private insurances are numerous but one factor you must think about is that patients who are 60+ or older than that will majorly have Medicare coverage so checking the same is crucial.
Do check if any health insurance prior authorization is required for the treatments that are going to be delivered since some insurance plans may cover your particular treatment but some won’t.
Ensure the referrals, health insurance prior authorization are entered appropriately into the system.
Know about some exceptional cases involved within the plan, some insurance plans do have a limit in benefits, which involves a time frame where the treatment must be delivered. Note that, in substance abuse and other psychiatric cases you need to inform the payer about the cases.
Find if there is a need for the collection of coinsurance, copay, or other deductibles.
Two important questions you should ask your patients are about their demographic details and next to that is whether they had a change in the insurance plan.

How does Sop help in the eligibility check?

Maintaining a standard operating procedure is useful when you’re dealing with Revenue cycle operations, in the case of eligibility and benefits verification services why you must consider having an SOP is it can help your working staff.

It gives an idea for your staff to how efficiently complete the procedure and how accurately to talk with your patients to collect pieces of information. Also in long term, this gives useful information for your new staff who are into the business.

Last thoughts

With the immense pressure that you are dealing with in your revenue cycle operations, we know how difficult is to maintain this standard. But being important and serving as a beginning to your RCM services you must not go wrong in this either.

Feel free to outsource insurance eligibility verification services with Practolytics, with our visibility and easy benefit-sharing option via email you can be tension free and focus on your patient care completely.