Insurance checks are an integral step in revenue cycle management (RCM). The process involves checking the patient’s coverage, benefits, and eligibility for proposed treatments and other healthcare services. Accuracy is essential to ensure precise billing and submit clean claims. Complex and time-consuming manual checks pose a major administrative burden, and also cause errors, resulting in delays, denied reimbursements, and front desk inefficiencies. Today, automation tools are transforming verification processes. Using automated insurance verification tools minimizes manual work, reduces errors, and supports fast, real-time benefits verification.
In this post, we explore automated insurance verification tools, and how healthcare professionals can implement and use them to streamline patient eligibility checks and improve front-end efficiency.
Simplify your workflow—
outsource your insurance verification to our experienced team for accurate, real-time results.
Why Automate Insurance Verification?
Manual insurance checks present several challenges:
- Delays in eligibility checks: Verifying coverage manually is a time-consuming process. Delays in eligibility checks slows down billing and claim submission processes, ultimately impact the revenue cycle.
- Risk of human error: When checking benefits and coverage, human errors result in inaccurate or incomplete patient information, miscommunication between providers and insurers, manual processing, and outdated insurance details. Coverage errors lead to claim denials.
- Staff time spent on repetitive calls and data entry: When verifying coverage manually, staff often have to make multiple calls to insurance companies. They also need to navigate payer portals for rechecking coverage details and repeatedly enter patient data into billing software. These repetitive tasks waste valuable time that could be spent on patients. In a busy healthcare setting, these issues can cause delays, claim denials, patient dissatisfaction, and administrative hassles.
Front office automation tools improve speed, accuracy, compliance, and RCM making the process of checking patient eligibility for healthcare services smooth and efficient.
Key Tools to Automate the Verification Process
Insurance eligibility verification automation refers to using advanced technology, software and AI tools for fast and accurate verification of patient insurance coverage, benefits, and eligibility. Automated tools seamlessly integrate with electronic health record (EHR) systems, clearing houses, and insurance databases, and handle large datasets and complex verifications with speed and precision.
Examples of leading automated insurance verification tools include:
Magical: an automation tool that helps with tasks like data transfer between systems during the verification process.
Here are four electronic tools to automate insurance verification:
- Real-Time Eligibility Verification Software
AI software systems directly interface with payer databases, electronic health records (EHRs) and practice management systems (PMS). They retrieve patient insurance information instantly from insurers. The software connects with hundreds of payers, allowing real-time verification of coverage. It allows you to verify out-of-pocket costs, prior auth requirements, plan exclusions, non-covered services, primary and secondary insurance, and more –- in seconds and on one platform. It can provide updated insurance claim status for multiple patients in seconds. CERTIFY Health, AdvancedMD, and Droidal are examples of dedicated software for insurance verification.
- Practice Management Systems (PMS) with Built-In Verification Features
These systems automate insurance verification, appointment scheduling, and billing. PMS can verify patient insurance coverage in real-time and come with built-in claim validation tools the help identify errors in claims before submission. Advanced systems offer real-time verification and provide accurate and uniform reports instantly. Their advanced features include deeper searches of insurance portals, pulling from more payors and more details such as patient history, frequency limitations, procedure-level coverage percentages, and network coverage. Once you set up your payers with their credentials or logins, these tools can retrieve comprehensive reports, offering further details like specialty codes, patient history, and frequency limitations. They provide all the necessary information, in one place, without any extra hassles. Epic, Cerner, and Athenahealth offer PMS systems with built-in insurance verification features.
- AI-powered Verification Assistants
These AI-powered verification tools use machine learning algorithms to analyze patient insurance data and flag inconsistencies or anomalies that might otherwise go unnoticed. For instance, they can detect mismatches in policy numbers, identify outdated coverage details, or highlight missing data—all in real time.
One top advantage of these assistants is that they can pull data directly from scanned insurance cards. Optical Character Recognition (OCR) combined with AI ensures that crucial details such as member ID, plan type, and payer details, are captured accurately and instantly. They can also process complex queries quickly, a task that could take humans minutes or even hours for each patient.
By eliminating manual processes in insurance verification, AI powered tools reduce administrative burden and speed up front desk workflow.
- RPA (Robotic Process Automation) Tools
RPA tools are an ideal option for automating high-volume, repetitive insurance verification processes. These software bots can log into payer portals, submit eligibility requests, download response files, and update practice systems. If your practice handles a large patient load, RPA can significantly cut the time and effort involved in daily insurance checks.
Since they mimic human interactions with digital systems, RPA tools can be implemented quickly without disrupting your practice workflow. From verifying hundreds of patients’ coverage status instantly or performing real-time eligibility checks during appointment scheduling, RPA ensures accuracy, speed, and efficiency.
Choosing the Right Automation Tool
When it comes to choosing the right tool for your practice, there are various factors considered.
Size of the practice: For smaller practices with limited patient volume, simple, user-friendly tools that integrate seamlessly with their existing practice management software would be suitable. On the other hand, mid-size to large practices that handle a high volume of patients daily may require more robust tool that reduce verification time and minimize manual errors. They can consider software with batch verification capabilities, RPA integration, or AI-powered anomaly detection.
Integration with current practice systems: Practices must choose the automated insurance verification tools that integrate seamlessly with their EHR, PMS and billing software.
Ease of use: The platforms should offer user-friendly interfaces and streamlined workflows. This minimizes the need for extensive training while maximizing staff productivity.
Support and updates: It’s important that support and updates are available for the automated system. Glitches can compromise insurance verification procedures with far-reaching effects. Timely support is essential for maintaining the security, functionality, and performance of the application. Updates often include new features, bug fixes, and security patches, while support can involve troubleshooting, resolution of issues, and guidance.
Benefits of Insurance Eligibility Automation
It’s clear that implementing healthcare verification software offers many benefits:
Boosts efficiency: Real-time automated insurance eligibility checks speed up the verification process, providing insurance coverage checks in far less time than manual methods take.
Reduced claim denials: By automating verification, practices can ensure accurate patient information and minimize errors, improving billing efficiency and RCM.
Reduces administrative burden: Automation frees up staff to focus on more strategic activities, such as patient care coordination and other productive tasks, improving overall efficiency.
Improves the patient experience: Automation streamlines the verification process and improves the overall patient experience by reducing risk of unexpected bills.
Supports compliance: Automated insurance verification systems adhere to HIPAA regulations, ensuring the security and confidentiality of personal health information (PHI).
Improves RCM: Automation ensures efficient verification and claim submission, contributing to faster processing and payment collection.
Why Outsourcing Insurance Verification Is a Smart Strategy
Outsourcing insurance checks to experts can streamline workflows, reduce claim denials, and optimize RCM. It reduces the administrative burden, and the need for in-house training and technology investments.
An insurance verification company with years of experience in handling medical and dental eligibility checks, Outsource Strategies International (OSI) offers comprehensive solutions leveraging skilled professionals, AI, and advanced automation. Our verification specialists are knowledgeable about payer policies and can ensure hassle-free, real-time patient eligibility verification for your practice. Our affordable outsourced insurance verification services for clinics, practices and hospitals are available in all 50 states.
Reduce claim denials and speed up verifications?
Talk to our insurance verification experts today!
More from This Author
