What is Insurance Eligibility Verification?
By: Abhilash Khalkar
Tags: Health Insurance, Insurance, Healthcare, Medical Claim, Medical

Image Source: Infinx

Insurance verification services are an inherent part of the medical billing procedure. As per recent research studies, a majority of the denials in insurance are caused due to improper insurance eligibility verification.

Insurance eligibility verification is a process wherein a patient’s insurance coverage is examined, to know whether he/ she is covered financially for a particular medical procedure. This task is often outsourced to providers of insurance verification services. These insurance verification services providers have a crucial task to accomplish since verification is an important part of billing and medical coding. Most cases are delayed when patients after their appointments refuse to have correct and detailed information regarding their medical policies, or because hospital personnel neglect to amend reports about medical coverage. Insurance verification services have a few important steps, which include:

Obtaining Patient Data

This step is one of the most important processes in insurance verification services since it lays the foundation for reference and any addition of further information. Insurance verification services often make sure to add information such as current diagnosis, drug allergies, medical history, address, date of birth (DOB), and name, among others. Information regarding the patient’s insurance company, emergency contact, and family doctor’s contact are also included.

Periodic Checks for Eligibility

This step addresses the concerns of whether a patient is financially covered by his/ her insurance company for a particular treatment. Improper verification of the same, causes inappropriate claims to be processed, which thus delays the payments. Hence, for insurance verification services providers there is little to no room for errors. However, appropriate methodology for verifications can resolve these issues.

A periodic check for eligibility of insurance coverage of insurance plans for a patient is very important. To ensure this, an information record regarding the patient’s precise medical history must be maintained. This information can also include details of the patient’s situation such as the birth of a child, divorce, and marriage among others; as this information can also affect the patient’s financial coverage. Insurance verification services also have to keep patients informed about their deductibles.

Pre-approval

Approval for insurance coverage for a particular treatment is often obtained from the insurance company before the surgery. This is to make the entire process smooth for the patient. This is the most important aspect of insurance verification services and is often a long and tedious process. A third party service company should continue with ensuring that all the paperwork is reliable and updated and that the customer is provided with accurate and comprehensive information.

Insurance verification services contact the patients and their insurance providers to enquire regarding any additional information to be added and re-confirm their entire information. The documentation required for pre-approved medical treatments and procedures is often less. To eliminate concerns by patients and creditors over any discrepancies between the billing sum and the ‘permitted’ amount, all parties are supplied with accurate details about co-insurance, co-payments, and deductibles. Once this process is accomplished the patient’s details are then added to the billing register to reflect the latest information.

Claims can be handled more efficiently, through appropriate insurance verification services, which can cause seamless processing of claims. This proper process ensures effective management of revenue cycles, enhanced patient care, and better cash flows.