One-Stop Solution For Revenue Cycle Management Services


A Quick Examination of How Your Eligibility and Benefits Verification Must be

Like poles repel, have you heard about this phenomenon, you must have witnessed it in a bar magnet. Similarly, your errors are more akin to ‘like poles’ to your claims you might think the information provided is similar to the correct one, but this can eventually lead to the repulsion of your payments for your claims. That is your payers will not get attracted by your claims.

To escape from this situation, one procedure that is in your hand is health insurance verification process. By thoroughly doing it to the fullest, you can make sure of closing the gaps that are prevalent in the claims submission.

When your hearing, there are a lot of terms that might revolve around healthcare for eligibility and benefits verification services. Some might say it has eligibility for benefits, and for some it’s verification, people also say coverage, but if you look closely they all mean the same which is used for eligibility and benefits verification services.

To be more precise and understandable, Evbv is the assurance that providers can get before giving services. On what? is that you’re thinking, then it is at the end you will receive confirmation that your patients are enrolled with the insurance policy and it is current, thus you can get your reimbursements without any conflicts.

Establish a routine for verifying each time

Before we enter into the part to reduce mistakes, here is some primary information you must be aware of. 

If you have an insurance id card it doesn’t mean that you will get payments. So verifying them every single time is imminent. Benefits differ from plan to plan, so identify if you can get full coverage for the services you’re delivering. With that methodology, you can project the revenue for the treatment you will be involved with.

An overview of the eligibility check 

In some cases, benefits and coverage verification need not be done elaborately but insurers will still need to evaluate the medical opinion and all services that you are planning to include on your claims to determine if you will be paid the most.

To achieve this, the following essential information must be included, which assist in the initial stages:

  • Name of the patient
  • Birth date
  • Insurance id
  • Insurance name

In addition to this, you might need more specific data on the codes and other details for specialty-specific one.

What functionalities you must include in your verification portal?

We all know accessibility is not only considered to be a feature but a collective trend. One simple and efficient portal must include the facility for providers to enter their details from wherever they are sitting. 

The second most thing you must consider is, it’s well admitted that providers will be working with more than one insurance plan, and the plan coverage’s differ drastically from one to another. So giving them options to check them all in one go, will help their task more easily. That’s why your portal must be a source of information for different insurance payers.

How your eligibility check is made run? 

It is okay to share work, be it one who runs a school or who runs the government, all need different organizations’ aid in different scenarios. If you’re already stuck between patient care and administration work, then opting to outsource insurance eligibility verification services to a third-party organization is well and good.

These companies help you to run eligibility checks with aid of their preferred portal-specific tools. Although the checks do not cover altogether information, they can give support information on how far you can expect in your pockets

Some companies do give options for health insurance verification of all your scheduled patients within a week or so on. These batch verifications can save you time and they can give you a result page together for the same. We at Practolytics value this time of yours and make sure of completing your add-on patient’s together, within the given time.

Multifarious benefits a platform needs to posses

The primary goal for the eligibility and benefits verification services is that we can get information about copay, and deductibles and give the tentative information way in advance. For quicker and real-time checks you must make sure that you follow the procedure before your patient visit. Who says no to extra benefits, even a small chocolate as a jackpot makes us feel to jump high in the sky. Having this facility in your portal will enable practices to have one investment, and three benefits, that is to get documentation facility, scheduling, and eligibility check in one go.

Initiate contact with the payers 

If you are someone who always relies on oral communication, then you can go for a direct call with your Payer. But for the majority time, you will be connected to a system of voice interaction and will get encrypted messages.

At times you can also go for a call with the working personnel from your payers’ side, but considering the long waiting times on the phone can make you frustrated. Still, your idea of contacting will get successful even with IVR as they provide basic eligibility information.

Last thoughts

The need for eligibility and benefits verification services is evident. The benefit is obvious for both the patients’ and providers’ interests. To be on the cautious side, you should also inform your patients that these benefits coverage is not assured and can vary with time.

Depending on the time, your patient influx change but your workload will not hit the down button as they will increase even if it’s reducing, for the necessity to effectively manage this workforce you can opt for a third-party organization or outsource eligibility and benefits verification services to other organizations that can work form your behalf.

We at Practolytics offer eligibility and benefits verification services and give allowable reimbursement collection that needs to be received from your patients and Payers.

prior authorization guide-practolytics

ALSO READBoost Your Profitability by Eligibility and Benefits Verification