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Medical & Dental Clinics, Practices and Hospitals

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Significant Reduction in Rejections and Denials

Insurance verification and authorization is of great importance when it comes to avoiding claim denials and rejections based on patient ineligibility. Lack of proper eligibility may lead to problems such as delayed payments, need for rework, increased errors, non-payment of claims, patient dissatisfaction and more. So, prior to admission of patients into the hospitals insurance eligibility of the patient has to be verified.

As part of the health insurance verification and authorization process, important data such as 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 are verified. Once the verification process is over, authorization is obtained from insurance companies via telephone call, facsimile or online program. In this way, insurance based coverage errors can be reduced, ensuring service providers minimal rejections and denials, and improving their bad debt write-off scores.

By outsourcing insurance verification and authorization services, all your concerns in this regard can be put to rest. Today, there are several outsourcing companies that ensure that all your necessary paperwork will get done promptly for timely reimbursement. They have a team of professionals to carry out the verification and authorization process to avoid last minute cancellations and to ensure accurate medical billing. In addition, they will find out whether all your requirements are efficiently met, complete all follow-ups and keep you updated regarding all processes. They will also keep in touch with insurance agencies/companies for appeals, missing information and more.

What to Look for in a Service Provider

Medical insurance verification services are available to practices of all sizes including hospitals, clinics, long term care facilities, acute care facilities and physician practices. Before handing over the task of medical insurance verification and authorization to a reliable outsourcing firm, make sure that they offer advantages such as:

  • A full research of all accounts to determine the necessary action and subsequent development of a prioritized action plan
  • Continuous evaluation of each account regarding the amount of returns possible and the timing
  • Provide regular QA checking with readily available reports
  • Weekly and monthly status reports
  • Follow all HIPAA guidelines

What You Stand to Gain by Outsourcing

By outsourcing insurance verification and authorization requirements, healthcare facilities can gain a wide range of benefits. Some of the major advantages of outsourcing insurance eligibility verification and authorization services are:

  • Reduced effort and time
  • Speed up approval and authorization
  • Reduce your risk factors
  • Simplified workflow
  • Reduced number of returned claims
  • Faster billing cycles
  • Minimize delays
  • Improve payment and collections
  • Reduced rework of claims
  • Reduced operational costs (save 30 to 40% of your insurance verification operational costs)

In addition, your workforce can be made free to focus on more productive tasks. You will have fewer claim rejections and much improved staff productivity. Your entire billing process will be streamlined and you will enjoy maximum reimbursement for services provided.