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Everything You Need to Know About Insurance Eligibility Verification

We humans always prefer assurance, how do you bring that sense within you, one way to bring is, by verifying. Healthcare and revenue cycle management operations deal with different stages of verification, one important area of service that needs to be focused on is Eligibility and benefits verification services.

This process in simple words is all about the verification of the patient’s insurance eligibility and benefits which are done by medical billing experts. It depicts the patient’s financial responsibility for the services offered to them. One way to achieve this is by making sure your working staffs collect and verify information of your patient’s insurance package before scheduling the appointment.

This article will give you insights of the different dimensions of perks that are involved in Eligibility and benefits verification services:

Why providers should have an eye on these tasks?

Last-minute confusions are always not a healthy sign for every task that we provide. With that notion, healthcare that is fast running to serve patients and improve health needs faster administrative works. As a provider with the health insurance verification, you can get three important benefits that cannot be neglected for your growth both financially and professionally.

They are as follows:

  1. Collecting payments in the first meet

The first important barrier that is blocking providers is not collecting payments from their patients on their first visit. This is due to the non-availability of insurance eligibility and copayment data, thanks to health insurance verification where providers can get data before their appointments thus facilitating them to collect payments from their patients without any hesitation.

  1. Can be earliest in getting authorizations 

Pre-authorizations are always a hardship if you’re starting late. To overcome this situation make use of your EVBV which provides a necessary source of data about the insurance benefits for each treatment. This allows providers to get health insurance prior authorization well enough before the consultation, and also the fact that these health insurance prior authorization don’t affect you even if the particular treatment was not done make it more convenient for you.

  1. Increase claim rates 

With these advantages and clarity that we get from the eligibility verification which was discussed above, we can ultimately achieve cleaner claims and higher claim rates by choosing the right one. When one or more insurance policies are there for one patient, by proper analysis you get the right one for your service which gives you proper reimbursements.

Advantage for patients

EVBV not only gives benefits to providers or healthcare personnel’s, rather it serves as a two-way factor for helping both the parties involved. One was discussed above i.e., providers, next is the patients. If you think deeply, not all your reimbursements can be covered under an insurance plan, then who to share with, it’s from patients, from whom we get dollars under copayments and with other names.

So, what is the benefit for them? This prior and earlier reveal of cost coverage will help them to be prepared for their financial part, and reduce last-minute stress for them. All are equal before a provider but unfortunately, all are not the same in their situations, which is the inequality of one’s financial status. A street vendor is not having the same ability as a company’s manager, then giving them choice to choose their provider who can give low cost treatments is possible with EVBV. Overall, it helps them in choosing a plan for services.


An important aspect to consider is that Eligibility and benefits verification services is the first step of the RCM process. They are crucial in providing information and there is a high chance of claims denial as well.

Different impacts that can harm you if you don’t have proper eligibility and benefits verification include:

  • Spending time on patients who don’t have active insurance policies
  • Failure to get health insurance prior authorization as earlier as possible for the insurance policy that didn’t cover your particular treatments
  • Loss of patient count. Clarity and credibility are two important criteria to look for when you’re in healthcare. Without the proper assurance of these two, you can’t get the trust of your patients that is the inability to explain coverage and other explanation benefits can make them troubled, and move to other providers.

Advantages to note

When you see advantages, it’s clear-cut as discussed above that health insurance verification gives an advantage for both patients and providers. But to be more specific, for healthcare revenue flow if you miss opportunities to collect payment then you’re missing your corresponding benefits from those dollars, each dollar note will help you in establishing your service more seamlessly.

Notifying patients of their responsibilities prior not only increase care and patient growth but also helps you in getting co-pays and patients part of revenue without any delay. Every physician cannot expect their claims to be processed earlier, so these copays are crucial in providing helping hands to providers. This simultaneously reduces you to run behind them every time for cash collections.

Process involved in verifying

Simple yet sophisticated. If you’re not having a proper real-time eligibility check option in your practice then it’s not an easy process for you. Considering the work involved in manual checks, and time dedicated in calling payers if you’re sitting for a patient a minimum of 5 to 15 mins or more can be wasted in your service time.

To understand the complexity of the process, understand the details and steps involved in it they are as follows:

  • As a first step, every verification involves the collection of patient particulars. That includes demographics like name, date of birth, insurance provider, and so on…
  • Copy of insurance card with information from both back and front sides.
  • Include the information of insurance details of patients in EHR and PM tool
  • With system support check patients’ eligibility by the service type given to them
  • With this checkup, you should simultaneously identify the following fields and get answers to the same.

                                Name of the policyholder

                                Is policy effective without an expiry date?

                                Patient’s copay and coinsurance

                                Deductibles from patient’s pockets

                                Will the service need insurance preauthorization?

                                If the provider is out-of-network or the plan is not under coverage

With proper health insurance verification inform patients about their responsibility and collect the appropriate amount from them.

Bottom line

As a provider your focus must be more on patient care, and it’s also crucial to make their administrative works easier. Without doubt eligibility and benefits verification services are giving vital advantages for both patients and make this process more efficient making use of real time data and using systemized workflows for the same can help in streamlining your verification. Automated check-ups and upfront collections are another important factor to be considered. 

If you want assistance try contacting Practolytics, we with comprehensive EMR system can run eligibility within seconds. We provide details about benefits via email and give you information then and there.

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