Benefit & Insurance Verification

Managing eligibility and benefits verification is crucial in minimizing claim denials and optimizing the revenue cycle in healthcare practices. According to industry reports, 70 to 75% of healthcare claims are denied due to patient ineligibility for the billed services. This often occurs when a patient’s policy has been terminated or modified, specific services are not covered, or benefits are limited.

Our team is dedicated to helping practices reduce these denials and shorten the accounts receivable cycle, ultimately increasing revenue. By implementing a thorough verification process, we significantly lower the risk of ineligibility issues and increase the number of claims successfully submitted for adjudication. Benefit and eligibility verification is often overlooked, yet it is a critical component that directly impacts collections in the healthcare revenue cycle.

Without proper eligibility and benefit verification, practices face numerous challenges, including denied or delayed payments, the need for reprocessing, diminished satisfaction among patients and staff, and increased costs associated with denial and appeals management. To address these issues, we leverage our staff, technology, and expertise to deliver cost-effective patient benefit and insurance eligibility services.

Our Eligibility Verification Services are designed to:

• Enhance cash flow
• Reduce denials and appeals of claims
• Minimize the provision of non-covered services

Our Insurance Eligibility & Benefits Verification Services include:

• Acquiring schedules from practices through various communication channels
• Verifying coverage for all Primary and Secondary Payers (if applicable)
• Contacting patients for additional information if needed (Client Option)
• Providing clients with comprehensive results, including details such as member ID, group ID, coverage start and end dates, co-pay/co-insurance information, and deductibles for both in-network and out-of-network services, along with maximum spending limits.

Related Services (optional):

• Obtaining pre-authorization numbers
• Updating patient demographics
• Reminding patients of payment obligations
• Alerting clients to any coverage or authorization issues