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It is imperative that medical care providers understand the importance of insurance verification services in the healthcare industry. It plays a major role in a hospital’s claims denial management program. Successful billing depends on successful eligibility verification. Health insurance verification is all about the process of checking a patient’s active coverage with the insurance company and verifying the eligibility of his or her insurance claims.

In order to avoid claim rejection, the verification process must be done before the patient is admitted into a hospital. Otherwise, it might lead to denials and need for rework. Patients would be ineligible for benefits when they provide wrong or outdated information, or when their policies have been terminated or modified. A simple error can result in claim rejection or denial, so you have to be sure it is being done correctly.

Maximize Reimbursement and Minimize Denials

A health insurance verification specialist, also called insurance verifier, plays a big role in the health insurance system. These professionals work with patients, complete paperwork, and verify patient information with the insurance carrier to maximize reimbursement and facilitate revenue cycle improvement.

The service includes 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 & pre-authorizations
  • Life time maximum, and more

Insurance Verification Process

Insurance eligibility verification involves many steps.

  • Receiving patient schedules from the hospital via EDI, email or fax
  • Verifying patients’ insurance coverage
  • Contacting patients for additional information
  • Updating the billing system with eligibility and verification details such as coverage start and end dates, member ID, group ID, co-pay information and much more.

Seek Professional Help from a Reliable Service Provider

To take the stress out of managing these tasks, it is better to outsource insurance verification services to an outsourcing company that can get your claims billed and processed accurately. Because of the importance of insurance verification services, it is imperative to select only experts in the field. A reliable company will help in all ways to meet your insurance verification demands. By outsourcing your requirements, you can gain many benefits including:

  • Reduced effort and time
  • Speed up approval and authorization
  • Simplified workflow
  • Faster billing cycles
  • Improved staff productivity
  • Reduced operational costs

Every healthcare practice should give primary importance to insurance verification services because this can greatly impact its bottom line. Rejections and improper payment result in rework and resubmission of the claim. So it is important that you select the right provider delivering quality and cost-effective patient eligibility verification services.