Insurance Verification
Outsource Strategies International (OSI) provides insurance verification services to not only determine if a patient is eligible but to outline all coverage details for the requested health care service. Outsourcing this task to us allows healthcare providers to focus on patient care. Verifying health insurance coverage and benefits before the point of service helps physician practices avoid claim denials and delayed payments.
Our Insurance Verification and Related Services
As the success or failure of each patient claim starts at the front desk, our team verifies coverage before the patient even comes into the office. To verify a patient’s coverage benefits, we utilize payer websites and call insurance companies directly. The comprehensive services that we provide for medical practices of all sizes, including specialty practices include:
Patient registration and scheduling
Patient enrollment
Insurance benefit verification
Insurance authorizations
Contacting patients, if necessary
Updating the medical billing system with verified details
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OSI has experience in authorizing up to 300 DME cases per day. In order to provide superior quality services, we have a dedicated QA team to monitor the production of the agents doing verifications and authorizations. The work of each agent is randomly audited to ensure that they are meeting a quality service standard of 98% or above.
Our Efficient Patient Eligibility Verification Process
- We serve a wide range of medical specialties including Physical Therapy, Orthopedics, Oncology, Dental, Chiropractic, Radiology, and Obstetrics and Gynecology.
- Our insurance verification specialists are experts in working with insurance companies directly to check patient coverage. They will verify plan type, plan exclusions, effective dates, patient policy status, primary and secondary payable benefits, in network and out-of-network benefits, out-of-pocket costs, referrals and pre-authorizations and other specific details online or by directly calling the insurance payers.
- We verify both government and other major medical insurance plans including Medicare and Medicaid. Our team has in-depth knowledge about how such plans work for different healthcare facilities such as hospitals, clinics, physicians’ practices, community centers, ambulatory surgical centers and more.
- We can use your practice’s software and scheduler to verify patients’ insurance benefits and perform related tasks.
- Our pricing is affordable and can be per eligibility verification, authorization or on an employee basis.
- We handle all types of claims including Liability, No-Fault or Personal Injury Protection (PIP), and Workers’ Compensation.
Our Unique Selling Points
Consistent coverage- Do not worry about turnover, vacations, sick days etc.
Free up your staff from waiting on hold with insurance companies.
We can work directly on your software or offline. You decide.
We can work on your schedule and stay ahead of schedule. Stay 3 to 5 days ahead of your schedule.
Get an experienced person working on our account. No hiring or training.
We can complete comprehensive verifications getting you the coverage information for all procedures and tests.
Identify a prior authorization needed before you see your patients.
Know your patients’ dental or medical coverage and plan custom treatments and identify non-covered services before providing them.
We are fully trained in most software and can work directly on your practice management system.
We have a QA team to ensure 98% accuracy. We also record the phone calls with the insurance representatives for QA purposes.
FAQs
Why Is eligibility verification important?
The insurance verification process is the first step in the medical billing process. Verifying patients’ insurance coverage before providing clinical services is crucial to reduce risk of claim denials and rejections. Checking patient coverage before the encounter will promote clean claim submission, improve workflow and reimbursement rates, and enhance patient satisfaction.
What information is needed for insurance verification?
- Co-pays
- Co-insurances
- Claims mailing address
- Deductibles
- Patient policy status
- Effective date
- Payable benefits
- Plan exclusions
- Health insurance caps
- Type of plan and coverage details
- Referrals and pre-authorizations
- Out of network benefits
- Primary and secondary insurance
- Lifetime maximum
- DME reimbursement
- Code/procedure specific coverages
- Out of pocket costs
- Prior authorization requirements
We have the expertise and resources to handle insurance verification for all specialties, including cardiology, radiology, pain management reproductive medicine and much more!
When and how is eligibility verification done?
- Entry of demographic details from the patient’s document and verification takes place after the appointment is scheduled.
- Coverage benefits are verified with both the secondary and primary insurer. We verify patient coverage details through calls to the insurer and insurance portals.
- We also communicate with the patient to collect any additional information needed for claims submission.
- All patient and insurance information are thoroughly scrubbed to ensure accuracy and completeness.
- The information is entered in the practice management system.
OSI has extensive experience working with all government and commercial insurance companies Blue Cross Blue Shield, United Healthcare, AETNA, and GHI. Our team has completed more than 2.5 million dental eligibility verifications.
How much do these services cost?
The cost will vary depending on the scope and complexity of the work. At OSI, we have two pricing options – per full time equivalent (FTE) or per transaction. Get a free trial before you sign up – call (800) 670-2809 or send an email to info@managedoutsource.com.
Why should I outsource my insurance verification tasks?
In practices that see a large number of patients, performing insurance verifications and authorizations can be time-consuming and tedious for the front office staff. Outsourcing this critical task to an insurance verification specialist will ensure that the process is handled with utmost precision.
OSI has knowledgeable and experienced staff who have extensive experience in handling insurance verifications and claim processing. They are well aware about the red flags to watch out for, what information is required, and what services are included and excluded in different insurance plans
Partnering with us comes with many benefits:
- real-time eligibility and benefits verification
- Dedicated team and project manager
- Stringent QA processes
- Regular reporting
- Cost savings of 30-40%
- HIPAA compliance
- No long-term yearly contracts
- No set-up fees or training fees
With our exposure, expertise and technical knowledge, we can streamline your insurance eligibility verification process, reduce claim denials due to eligibility issues, and improve your revenue cycle management.
Outsourcing your medical billing to OSI can save you up to 40% on your operational costs.
Call Our Toll-Free Number
To learn more about our medical billing and coding services or to discuss your requirements with our Solutions Manager.
OSI Featured Experts
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Natalie TorneseCPC: Director of Revenue Cycle ManagementNatalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.
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Meghann DrellaCPC: 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 DarstSolutions Manager: Practice and RCM
Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.
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Loralee KappSolutions 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.
