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Insurance Eligibility Verification
And Prior Authorization

Reduce Claim Denials.
Optimize Collections.
Payment collection is a big challenge for even the most established medical practices. There are many steps a practice can take to improve billing and collections. However, it all starts with ensuring that the insurance eligibility verification and prior authorization processes are as efficient as possible.
What is Insurance Eligibility Verification?
Insurance eligibility verification is the process by which medical practices confirm the status of a client’s insurance policy. It helps ascertain if
(a) will the insurance policy of the patient cover a medical service/ procedure
(b) up to what value?
It tells the practice staff the health plan status (active/ inactive), the co-payments, coverage, deductibles, and coinsurance.

A defunct eligibility verification process will significantly increase claim denials and decrease a medical practice’s chances of getting paid.

What is Prior Authorization?
If insurance eligibility verification indicates coverage, prior authorization throws light on the specific conditions under which the claim will be honored by the payer for a medical prescription, service, tests, treatment, or procedure.
While a prior authorization does not guarantee payment of a claim, obtaining the approval improves the chances of the claim being met. The prior authorization conditions can be as follows:

  • The period within which the medical service should be performed.
  • The number of physician visits approved for the medical condition in a specified period.
  • Other requirements are specific to the prior authorization issued by the payer.
    Why should you Outsource Insurance Eligibility Verification and Prior Authorization to Elite Offshore Resources?
    Here is our end-to-end verification and prior authorization process:

    • Checking the patient’s eligibility and obtaining prior authorization before the patient visit.
    • Follow-ups for approvals through the payer’s portal.
    • Verify patient demographic information.
    • Verify coverage of benefits with the patient’s primary and secondary payers.
    • Update your practice management system with the approvals and other information received from the payer.
    • Claim denial appeals where required.

    Benefits of our eligibility and benefits verification and prior authorization services:

    • Lower cost of billing and collections- A markedly higher first-time-right percentage of clean claims means you collect more with lesser administrative effort. Let’s not forget the US dollar to Indian Rupee parity which works significantly in your favour.
    • Improve patient satisfaction- Patients want to know if they have coverage and what is their share of the expense. With our insurance verification team and prior authorization experts working diligently on each patient file, your patients are guaranteed timely and accurate answers.
    • Lower your accounts receivables - Lesser claim denials and clarity on the amounts you must collect from patients will reduce the likelihood of ageing claims.
    • A one-stop-shop for all major payers – We work with prominent private and government healthcare payers across specialties and states.
    • Improved focus on patient care – With the administrative processes being handled by us, you and your staff can focus on patient care.

    Outsource both these processes to Elite’s medical coding and billing team to save costs, boost revenues, and grow your practice.

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