Insurance Eligibility Verification
Reduce Claim Denials.
Optimize Collections.
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) 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.
Prior authorizations are classified as prescription prior authorization and medical authorization. While a prior authorization does not guarantee payment of a claim, obtaining the approval improves the chances of the claim being honored (provided the PA conditions are 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 that are specific to the prior authorization issued by the payer.
Prior authorizations are classified as prescription prior authorization and medical authorization. While a prior authorization does not guarantee payment of a claim, obtaining the approval improves the chances of the claim being honored (provided the PA conditions are 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 that are specific to the prior authorization issued by the payer.
Top Challenges in Insurance Eligibility Verification Prior Authorizations
Insurance verification processes are cumbersome and rejected claims can cost a medical practice thousands of dollars in rejected claims.
Procuring prior authorizations requires coordination with patients, payers, and other providers, a significant time drain on the already taxed practice staff.
Retrospective claim denials are a reality, possibly due to several reasons.
It is challenging to keep up with the changing payer guidelines on pre-authorizations.
Hiring and training billing staff to handle these processes is time-consuming and expensive
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Benefits of our eligibility and benefits verification and prior authorization services:
Outsource both these processes to Elite’s medical coding and billing team to save costs, boost revenues, and grow your practice! Here’s how you can benefit from 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. And let’s not forget the US dollar to Indian Rupee parity which works significantly in your favor.
• 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 aging 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.
• Lower cost of billing and collections- A markedly higher first-time-right percentage of clean claims means you collect more with lesser administrative effort. And let’s not forget the US dollar to Indian Rupee parity which works significantly in your favor.
• 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 aging 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.
Our end-to-end verification and prior authorization services include the following:
-> Checking the patient’s eligibility and obtaining prior authorization before the patient
visit.
-> Follow-ups for approvals through the payer’s portal.
-> Verify patient’s 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.