Insurance Eligibility Verification

Insurance eligibility verification is the most important and the first step in the medical billing process. Research confirms that most of the claims are denied or delayed due to inadequate or incorrect coverage information provided by the patients during visits and current coverage information not updated by the office / hospital staff. This lack of or improper insurance eligibility verification directly impacts the reimbursements.

why Insurance Eligibility Verification?

Insurance companies regularly make policy changes and updates in their health plans. Therefore, it is important for the medical billing company or the provider to verify if the patient is covered under the new plan to get maximum reimbursement. Confirming the insurance coverage facilitates acceptance of the claim on the first submission, whereas non-verification leads to several discomforts like rework, decreased patient satisfaction and increased errors other than causing delays and denials.

Benefits of Insurance Eligibility Verification

1.Easy, Efficient & Cost Effective

Are you or your staff tired of waiting on the phone or jumping from website to website to verify patients’ insurance eligibility? Being able to verify a patient’s eligibility and benefits information in a timely manner is critical. To do this consistently, you need support that is easy, efficient and cost effective.

2.Get Complete Information From One Source

Porteck’s insurance eligibility and benefits verification service obtains all pertinent information required – not only coverage confirmation, but what kind of coverage the patient has, what their deductible is, and how much has been applied. Having all necessary information generates more revenue and reduces administrative costs.

3.Simplified Eligibility Verification Process

MDEligibility increases office efficiency and staff production by eliminating hours on the phone or using multiple websites to obtain eligibility information. Further, it reduces the number of claim delays and denials by receiving timely coverage response.

Advantages of Insurance Eligibility Verification

  • Find your patient’s eligibility without the patient’s ID card
  • Gain direct access to Medicaid, commercial insurance or Medicare (Part A, some products) databases
  • Receive your response formatted for quick reading and easy interpretation
  • Review a comprehensive list of covered services
  • Retain an electronic or printed document to support appeals for rejected claim payment
  • Look back 12 months for eligibility history (some plans)