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Medical Eligibility - Verification Services

Depending on the size of your health care facility, or whose management you’re under, you may have a team of insurance and compliance employees who handle payment and insurance issues and are adept at managing and processing claims with the insurance companies. But if you don’t, there are some important procedures to follow that will help you facilitate this fundamental part of running a health care office.

Our Staff will contact the patient’s health insurance carrier to get the following information for medical eligibility checks:

  1. Patient is indeed covered by the insurance
  2. Insurance coverage effective dates
  3. In-network or out-of-network coverage
  4. Service(s) you are seeing the patient for are covered. Do they need pre-authorization and/or a referral by a primary care physician?
  5. Amount of co-pay for services, if any
  6. Deductible amount–has the deductible been met for the year?

When the patient arrives for their appointment, you’ll want to make a copy of their photo ID and their insurance card and collect any applicable co-pay.

How much time does your staff spend checking a patient’s insurance eligibility?

Verifying a patient’s insurance eligibility is a tedious process that your staff performs multiple times a day. Eligibility verification can mean several phone calls and visits to several websites before you have an answer.

Some practices choose to check the eligibility of their patients once they have already checked into their appointment, but with this approach, you run the risk of a patient being seen without the proper – or adequate – coverage. Especially for out-of-network or specialist providers, the patient can be upset over the cost of the bill, which is often more than they expected.

The Benefits of Eligibility Verification Services

Let our team be an extension of your office and handle your eligibility verification in a more timely manner.  Free up time for your staff to concentrate on delivering fast and patient-centric service. Decrease the number of upset patients by letting us handle the eligibility checks. Increase the number of patients seen each day through a more streamlined front-of-house.

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