How Insurance Verification and Authorization Services Help Medical Practices

by | Last updated Dec 7, 2023 | Published on Sep 23, 2011 | Insurance Verification and Authorizations

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Verification of Benefits from Primary and Secondary Insurance Companies

Healthcare practices have to carry out medical eligibility verification of a patient to make sure that the services provided are covered. Most of the medical practices do not have enough time to carry out the difficult process of insurance eligibility verification. Providers of insurance verification and authorization services can help medical practices to devote ample time to their core business activities. So, seeking the help of an insurance verification specialist or insurance verifier can be extremely helpful in this regard.

A reliable and highly proficient verification and authorization specialist will work with patients and providers to verify medical insurance coverage. They will also provide complete support to obtain pre-certification and/or prior authorizations. They have:

  • Experience with insurance guidelines of various providers, knowledge regarding healthcare terminology, and medical/surgical techniques
  • Good communication skills
  • Good typing skills
  • Excellent computer skills
  • Call center/customer service experience

The Process of Insurance Verification and Authorization

You can expect the help and assistance of insurance verification specialists at each stage of the process.

  • Verify benefits for all patients prior to submitting to insurance for approval
  • Receiving patient schedules from the hospital or clinic via FTP, Fax or E-mail
  • Verify patient information with the insurance carrier (verification of payable benefits, co-pays, co-insurances, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, claims mailing address, referrals and pre-authorizations, life time maximum and more)
  • Verify patients’ insurance coverage on all primary and secondary payers
  • Update patient accounts
  • Verify insurance required criteria is correct
  • Communicate with patients and complete paperwork
  • Obtain pre-certification number from physician’s office if necessary
  • Complete appropriate criteria sheets and authorization forms
  • Resolve potential problems with coverage
  • Contact the insurance agencies on your behalf to obtain approval for your authorization request

They will also communicate with insurance agencies/companies for appeals, missing information and more to ensure accurate billing. Once the verification process is over, the authorization is obtained from insurance companies via telephone call, facsimile or online program.

Benefits of Outsourcing Insurance Verification and Authorization Tasks

Besides helping medical practices to focus on core issues, insurance verification and authorization services offer a wide range of benefits including:

  • Simplified workflow
  • Reduced number of returned claims
  • Faster billing cycles
  • Reduced effort and time
  • Speed up approval and authorization
  • Reduce your risk factors
  • Free up workforce to focus on more productive tasks
  • Reduced operational costs (save 30 to 40% of your insurance verification operational costs)
  • Fewer claim rejections
  • Improved staff productivity
  • Streamlined billing process
  • Lower bad debt write-offs
  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

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    Amber Darst
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    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.