Patient Eligibility Verification Process in Medical Billing

The patient eligibility verification process involves determining whether a patient’s insurance coverage matches the billing procedure performed. This can happen for many reasons: The patient may be billed for another procedure to a different physician, or the incorrect procedure was claimed as covered in their insurance policy.

If you are like most people, you find it hard to get the information you need out of your insurance company. We experience the same thing, so we have learned how to talk with them. We have a dedicated team that is trained in understanding health insurance plans and benefits. We will verify your eligibility so you know what to expect when you come in for your visit.

Our Primary Insurance Verification Process:

Patient’s eligibility verification aids healthcare providers in submitting error-free claims. eligibility-related rejections and denials, increases collections, and improves patient satisfaction by avoiding claim re-submission. Additionally, confirming authorization requirements before to providing service reduces denials and helps to enhance collections. The work log, EDI logs, Fax, emails, and FTP files are how we get our process. We then double-check primary and secondary coverage information, such as the patient’s ID number, group ID, coverage period, co-pay, deductible, and insurance eligibility verification process as well as benefit information. To contact the payer, we phone or look at web portals. In the event that any information is missing or incorrect, we contact the patient.

Eligibility verification is a critical step in the end to end medical billing process. It allows the provider to ensure that they receive reimbursement for services rendered. Without eligibility verification, providers may not get paid because the insurance carrier is unable to identify the patient’s coverage and/or benefits.
Eligibility verification aids healthcare providers in submitting error-free claims. It reduces eligibility-related rejections and denials in RCM, increases collections, and improves patient satisfaction by avoiding claim re-submission. Additionally, confirming authorization requirements before to providing service reduces denials and helps to enhance collections.

This information is important because it confirms that the patient has insurance and that their plan covers the procedure they are having. It is also used to calculate the portion of their bill that they will be responsible for paying. The eligibility verification process as well as benefit information. To contact the payer, we phone or look at web portals. In the event that any information is missing or incorrect, we contact the patient.