Role of Insurance Verification and Authorization in Medical Billing

by | Last updated Dec 18, 2023 | Published on Mar 5, 2014 | Resources, Articles, Insurance Verification | 0 comments

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Insurance verification and authorization plays a significant role in hastening the medical billing process. Verifying insurance eligibility and receiving authorization is essential to avoid claim denials and patient ineligibility based rejections. Medical insurance verification and insurance authorization involves validating the patient’s insurance details with the appropriate insurance payer.

The insurance verification process ensures verification of: payable benefits, patient details, pre-authorization number, co-payments, deductibles, co-insurance, 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.

Comprehensive Insurance Verification and Authorization Services

The health insurance verification and insurance authorization process includes:

  • Ensuring benefits for all patients prior to submitting to payers for approval
  • Getting patient schedules from the hospital or clinic via FTP, Fax or E-mail
  • Verifying 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)
  • Verifying patients’ insurance coverage on all primary and secondary payers
  • Updating patient accounts
  • Communicating with patients and completing paperwork
  • Obtaining pre-certification number from physician’s office if necessary
  • Completing appropriate criteria sheets and authorization forms
  •  Contacting the insurance agencies via telephone call, facsimile or online program to obtain approval for your authorization request
  • Making contacts with the insurance agencies for appeals, missing information and more to ensure accurate billing.

Other optional services which are provided as part of the insurance eligibility verification process are: obtaining pre- authorization number, obtaining referral from PCP; reminding patient of POS collection requirements; informing client if there is an issue with coverage or authorization and Medicaid enrollment.

For most healthcare providers, insurance verification and authorization is a time-consuming and tedious task. But, they are aware of the importance of these tasks in making the billing process successful. It is advisable to outsource the entire process of insurance benefit verification and insurance authorization to a reliable service provider. Outsourcing of health insurance verification and insurance authorization allows medical professionals to concentrate on core issues and provide quality healthcare.

By outsourcing, you can expect the assistance of an insurance verification specialist at each stage of the process. They will take care of the entire process from making calls to the local insurance agencies and following up with them to getting the documentation done in the end. Thus, all your concerns regarding insurance eligibility verification can be put to rest by seeking the support of a competent medical billing company.

Outsource Strategies International.

Being an experienced medical billing and coding company in the U.S., OSI is dedicated to staying abreast of the latest industry guidelines. Our services provide comprehensive support for the success of your practice.

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