WHAT IS ELIGIBILITY AND BENEFITS VERIFICATION?
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Eligibility and benefits verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and what are not. This step helps provider to identify whether the treatments or services going to be rendered are covered or not by the patient’s insurance plan. This will make provider’s life easier. If certain service is not covered under patient’s plan, then provider either avoids performing that service or approach patient well in advance to be ready to pay for non-covered service/s.
During this step, healthcare providers are collecting details such as the patient’s insurance policy number, the name of the insurance company, the type of plan, and out of pocket details (like: co-payment, coinsurance and deductible amounts). This will give clear picture regarding future reimbursement. By doing this, we can get idea about not only sharing preposition between insurance and patient, but also the provider status (in network or out of network) with the patient’s plan. And this helps provider to make their plans to get reimbursement of services rendered.
Requirements of Eligibility and Benefits Verification:
Eligibility and benefits verification is very important process for medical practices, because it is having direct impact on revenue cycle management. As a medical practice, it is become very important to verify eligibility and benefits to ensure that patients will receive the appropriate level of care and on the other hand provider will also get reimbursement for each services rendered.
Here are some reasons that proves why eligibility and benefits verification is vital for every medical practice:
One of the major challenges that all medical practices are facing is claim rejections due to inaccurate or incomplete patient demographic details. Once the claim is rejected, it caused delay in payment collection, duplicate work, and additional administrative costs to fix the error. By conducting eligibility and benefits verification in advance, practices can avoid such claim rejections and ensure timely reimbursement for services rendered.
Eligibility and benefits verification are helped to improve cash flow by minimizing the number of unsettled claims and denials.By verifying a patient’s insurance coverage and benefits prior to provide any medical services, provider can determine the expected payment amount as well as assurance that the provided services will be fully covered by the patient’s insurance plan.
Eligibility and benefits verification can also improve patient satisfaction by reducing the likelihood of unexpected medical bills. If certain service is not covered by the patient’s insurance plan and we informed after claim is denied, will create burden on patient to setup big amount to settle medical bill. In addition to that, due to lake of transparency, patient is very likely to visit the same clinic in future. If patient is aware about out of pocket and non-covered charges well in advance, then patient can be prepared both mentally as well as financially.
Performing eligibility and benefits verification can also help practice to streamline operations and reduce administrative costs. It reduces rejections, denials as well as double work on same claim to get paid.
Advantages of Outsourcing Eligibility and benefits verification to Ingenious
One of the crucial elements of Revenue Cycle Management (RCM) is eligibility and benefits verification. The detailed and on time benefit verification is not possible by in-house staff. It is time-consuming as well as complicated task. It does require multiple resources and proper guidance. Hence, providers cannot afford it to be done in-house. This is where Ingenious helps.
We offer the best and affordable eligibility and benefits verification service for medical practices. Here’s why:
Our team of experts is highly trained and experienced in navigating the complexities of insurance plans, coverage, and benefits. We can quickly and accurately verify a patient’s eligibility and benefits that can help reducing errors and claim rejections.
We use innovative technology to streamline the verification process, lowering administrative expenses and increasing efficiency. Our technology allows us to automate the verification process, saving time and resources for your medical practice.
Outsourcing eligibility and benefits verification to us can result in cost savings for your medical practice. By eliminating the need for in-house staff to handle the verification process, you can reduce labor costs and avoid the need for expensive software and technology.
We believe in one touch solution. So, our eligibility and benefits verification service can help providers to improve cash flow by minimizing the number of claim rejections and denials. By verifying patient insurance information well in advance, we can reduce the chances of unpaid claims and denials.
We have created special forms for in-network and out-of-network benefits. These forms include everything related to eligibility. These forms are customizable, so we are making changes according to providers’ requirements. This way provider can easily identify whether certain procedure code will be covered or not? Is any of the procedure code required authorization or not? What is out-of-pocket? What is annual deductible and how much is already mat? In sort, you will get answer of all your queries related to eligibility and verification by reviewing these forms.