Eligibility & Verification
Eligibility & Benefits verification is one of the top most integral part in the Medical Billing process. As per the industry research, most of the insurance denials occur due to improper coverage information.
Insurance companies frequently make policy changes and updates in their health plans. If the provider or the billing office is not aware of these changes, this may directly impact the practice revenue. Therefore, verifying patient’s Eligibility & Benefits becomes inevitable part in the Medical billing process.
We at Purview Healthcare have built a template for verifying and updating the member’s benefits and Eligibility.
Eligibility & Benefits Verification process at Purview Healthcare
We pull the patient’s schedule from the EMR system
We call the payers directly/IVR or verify the eligibility & benefits through authorized online insurance portals and obtain the patient’s eligibility information like
- Member ID number
- Coverage effective & termination dates
- Primary & Secondary coverage details
- Deductible and Co-pay information
- If policy termed, other insurance coverage details and a detailed list of benefits depending on the patient’s plan.
The eligibility & benefits information is directly uploaded in the respective patient account in the billing system. A copy of the report will be e-mailed to the client before the patient visit the doctor office.
Our insurance verification team follow a standard questionnaire while verifying the patient’s eligibility & benefits. This questionnaire has been built in a way to zero out any rejections from the payers and ensure all the claims sent out reaches the payer as a Clean Claim resulting in maximizing the revenue of the practice