Optimizing Revenue Through Benefit & Eligibility Verification

One of the primary reasons for healthcare claim denials—accounting for 70 to 75% of cases—is a patient’s ineligibility for the services billed to the insurer. This ineligibility often arises due to policy termination, modifications, or the exclusion of specific services or benefits.

To combat these challenges, our approach focuses on reducing denials and shortening the accounts receivable cycle, ultimately boosting your practice’s revenue. Our comprehensive verification of benefits process significantly mitigates the impact of ineligibility and ensures a higher percentage of claims are successfully adjudicated by insurers.

Benefit and eligibility verification are often overlooked, yet they play a crucial role in the healthcare revenue cycle, directly influencing collections.

Without proper verification, practices face several issues, including denied or delayed payments, reprocessing, reduced patient and staff satisfaction, and increased costs associated with managing denials and appeals. Our solution deploys a combination of skilled staff, advanced technology, and expert management to deliver efficient and cost-effective patient benefit and insurance eligibility services.

IHEALTHCARE Eligibility Verification Services has the potential to:

• Improve cash flow
• Decrease denials and appeals of claims
• Decrease providing non covered services

Our Insurance Eligibility & Benefits Verification Services Include:

• Obtain Schedules from the practices via various forms of media
• Verify coverage on all Primary and Secondary Payers (if applicable)
• Contact patient for information if necessary (Client Option)
• Provide the client with the results which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay/co-insurance information in and out of network deductibles with maximum spending amounts.

Related Services (optional):

• Obtain Pre- Authorization Number
• Obtain referral from PCP
• Update Patient demographics
• Remind patient of patient payment requirements
• Inform client if there is an issue with coverage or Authorization