It is the process whereby we verify patient insurance eligibility/ insurance coverage to determine the quantum of benefits that a patient is eligible for under their insurance plan. Carrying out this real-time insurance eligibility verification will determine whether the particular treatment is covered under the policy and also how much the patient will have to pay as a copay for the healthcare services received. Thus proper eligibility verification in medical billing will increase your upfront collections. 

Many practices do not give importance to insurance verification in medical billing, which ultimately results in delayed reimbursement or rejection of claims at times. Health insurance eligibility verification helps you to submit clean claims. Eligibility verification in medical billing should always be done before the patient visits and not left to be done as a back-end process. Also, verifying authorization requirements before patient visits avoid denials by payors. 

US Medical Billing Services will ensure that medical insurance eligibility verification and prior authorization are done correctly to avoid rejections/denials and increase collections. Eligibility verification services are given the same attention and care as the other back-office services, for we understand its importance in the overall revenue cycle management process.

During the health insurance eligibility check, we note all information from the insurance card, we talk to the patient and we also contact the payor. We are thorough while verifying insurance eligibility with the payor regarding the current status of the insurance plan. 

Through patient eligibility verification, the data collection (to populate the medical records of the patient) should include

• Insurance name, phone number, and claims address
• Insurance ID and group number
• Name of insured (if not the patient)
• Relationship to the patient
• Effective date of the policy
• End date for the policy
• Whether the insurance coverage is active
• Whether the insurance covers the procedure/diagnosis/treatment 
• Whether your practice is linked to the plan
• Details of exclusions or documentation requirements for bills
• The patient’s copay amount and deductible

Our insurance eligibility check will obtain all this data to complete the process of health insurance verification. We make sure that claim forms have accurate data to facilitate quicker reimbursement for you.

Our team of billers will verify health insurance of the patient and note all the information necessary (listed above) that will enable us to prepare clean claims. Next, we check with the payor regarding the insurance coverage and then follow-up with the patient.

We speak to the patient to let them know about copays and other issues. Letting the patient know early about out of pocket expenses will increase the chances of collecting the funds and patients are also satisfied that they are aware of copays.

Where prior authorization is needed, we submit the requisite paperwork to the payor. We follow-up the request with the payor and notify the client if there are any issues with the authorization request.

Through our eligibility verification in medical billing services, we ensure steady cash flow for you through quick reimbursement. We reduce rejections/denials due to incorrect patient data. We identify patient responsibility for an upfront payment and intimate them. Our goal is to satisfy healthcare providers and through them, their patients.