How Does Insurance Eligibility Verifications and Pre-Authorizations Work?
Most claim denials are due to not properly verifying benefit information prior to services being provided. Insurance eligibility verification and prior authorization is the first and vital step in the medical billing process. Insurance verification process is crucial for all encounters, whether inpatient, outpatient or ambulatory care.
To avoid claim rejection, the verification process must be done before the patient is admitted into a hospital, sees a physician or gets services from a medical professional.
Coverage and eligibility benefits should be verified for
all new patients
any patient who indicates a change to their coverage, and
for all high dollar procedures
Outsource Strategies International (OSI) can assist physicians and healthcare practices with their insurance eligibility verifications and pre-authorizations.
Our health insurance eligibility verification services are meant to help you
minimize rejections and denials and
improve bad debt write-off scores
reduce coverage errors
Knowledgeable in each and every aspect of health insurance, healthcare terminologies and medical/surgical techniques, our verification specialists work with payers as well as patients to verify eligibility and obtain authorizations for services or procedures to be provided.
Insurance Eligibility Verification – Step by Step Process
Receiving patient demographic information from referral sources such as hospital or clinic or from the patient directly.
Verifying patient information with the carrier. This service includes verification of:
- payable benefits
- patient policy status
- effective date
- type of plan and coverage details
- plan exclusions
- specific coverage
- claims mailing address
- referrals and pre-authorizations
- life time maximum
Verifying patients’ coverage on all primary and secondary payers
Updating patient accounts
Communicating with patients and completing paperwork
Obtaining pre-certification number when it is needed for a procedure, visit or other treatments
Completing appropriate criteria sheets and forms
Contacting the insurance companies on the physician’s behalf to obtain approval for your authorization request
Once the forms are filed either online or via a web portal, then the specialist will follow up until authorization is received
If any further documents are necessary, we will make arrangements to get those
Our specialists can also communicate with companies for appeals, missing information and other details to ensure accurate insurance billing. Once the verification process is over, the authorization is obtained from insurance companies via telephone call, facsimile or online program.
Why Are We Good at What We Do?
- We work directly in your software or out
- We work to stay ahead of your schedule and the verifications are done before the patient comes into the office
- Our cost is lower than hiring an in-house verification team and you are getting an experienced person to work for you
- Our team can identify when a prior authorization is needed and thus prevent denials for services provided.
- Our QA team ensures that we meet 98% accuracy. We also record the phone calls with the insurance representatives for QA purposes.
No need to train employees on software. Hiring an employee through us saves you money on taxes and other staff benefits.
Knowing patients’ dental or medical coverage can help you plan custom treatments and identify non-covered services. Our team is also experienced in providing dental eligibility verification services for dental care providers.