What Is Health Insurance Eligibility Verification?
To verify insurance eligibility, it is necessary to receive verification. Health insurance eligibility verification is the process of checking if a patient’s health insurance is active and covers the medical services they need. When you go to the doctor, the office will verify insurance eligibility.
They check if your health insurance is current and valid. They also check what medical services your insurance will pay for. Without knowing how to verify insurance eligibility, the practice will lose money or may not be allowed to provide services.
The Impact of Insurance Eligibility Verification
For healthcare providers, verifying insurance eligibility means they can be more sure of getting paid for their services. When they know a patient’s insurance is active and covers their services, they can bill the insurance company directly. This can speed up the payment process.
If a healthcare provider doesn’t verify insurance eligibility, they might provide services and then find out the insurance won’t pay. Then they have to bill the patient directly, which can take longer and be more difficult.
Insurance Effects for Patients
For patients, insurance eligibility verification can affect how much they have to pay out of pocket. If their insurance is active and covers the services they need, they will usually only have to pay a small amount, like a copay.1If their insurance isn’t active or doesn’t cover the services, they may have to pay the full cost. This can be a lot of money, and it can be a surprise if they weren’t expecting it.
The Insurance Eligibility Verification Process
When you verify insurance eligibility, it is more than just ticking off a box. It’s a comprehensive process that starts with recording the patient’s information and ends with properly filing claims.2The following steps are a general outline to verify insurance eligibility:
Collect Patient Information
Before you can begin to verify insurance eligibility, you first need to gather information about the patient. This includes details such as their full name, date of birth, and contact information.You will also need information specific to their insurance, like their insurance provider’s name and policy number. This data is usually collected from the patient directly, often through a form they fill out in person or online.
Enter Data Into the System
With the patient’s information, you will now enter the data into your system. This could be a specific insurance verification system or a general healthcare management system that includes insurance verification functionality.
Verify Eligibility
Now we arrive at the core task: to verify insurance eligibility. Your system will use the patient’s information to check with the insurance company.
This is usually an automatic process, and the system sends a request to the insurance provider’s database.
Check for Coverage
In this step, you examine the details of the patient’s insurance coverage. The data from the insurance provider tells you what healthcare services the patient’s policy covers.
Some policies cover a broad range of services, while others are more specific. The insurance provider’s database should provide you with all the information you need to determine what services and treatments the patient can access.
Additional Steps to the Insurance Eligibility Verification Process
There can be multiple other steps to the insurance eligibility verification process. The steps to verify insurance eligibility include the following:
Obtain Authorization
To obtain this authorization, you need to send a request to the insurance company. The request includes details about the patient and the planned service. The insurance company then reviews this request and, if they approve, will provide an authorization number that you can record in your system and verify insurance eligibility.
Collect Payment
If the policy includes a co-pay, the patient will need to pay this amount at the time of service. If there’s a deductible, the patient might need to pay for the service in full until they reach the deductible amount.In some cases, the insurance covers the service completely, and you don’t need to collect any payment from the patient.
Submit a Claim to the Insurance Company
After the service is completed, you need to submit the claim to the insurance company. Most providers use a software system or an online portal for this step.
The information you submit will include patient and provider data, diagnosis codes, and service details like what was done and the cost. Depending on your provider agreement with the insurance company, you’ll either receive reimbursement for the allowed amount or payment will be sent directly to the patient.
Receive Payment/Reimbursement
Once the claim is processed, you’ll receive payment or reimbursement from the insurance company. The amount you’re reimbursed will depend on the coverage and any deductibles or copays that are applicable. You may need to follow up with additional documentation if there are questions or disputes related to the claim.
How Can Providers Ensure Accurately and Timely Insurance Eligibility Verification?
Accuracy and timeliness in verifying insurance eligibility are both helpful. When you verify insurance eligibility accurately, you help to avoid billing errors.
Billing errors can lead to claim denials, which can delay payment and create more work for your office.
Strategies for Ensuring Accuracy
To verify insurance eligibility accurately, you can use a few strategies. First, you should consider the accuracy of the data sources. Insurance carriers are constantly updating their records, and it is important to access the most up-to-date information.
You can do this by leveraging technology, such as automated eligibility and benefit verification systems. These systems are designed to access accurate information in real time from the carrier.
You can also take advantage of features such as electronic remittance advice (ERA) to gain further insight into patient eligibility and coverage.
Techniques for Timely Verification
To verify insurance eligibility in a timely manner, consider these techniques. First, verify eligibility as soon as you have the patient’s information. This allows you to resolve any issues well before the patient’s appointment.
Second, consider using a system that offers real-time verification, which immediately gives you the patient’s eligibility status. This system can also be integrated with your existing workflows, such as appointment scheduling and billing.
Finally, implement an organized system for monitoring eligibility. You can use tools such as automated reminders to stay on top of when coverage may expire. This will help ensure you get all the important deadlines for eligibility updates.
How Can instantvob® Help in Insurance Eligibility Verification?
instantvob® offers a service that’s ready whenever you are. It’s a solution designed to verify insurance eligibility quickly and accurately estimate reimbursements.
The aim of instantvob® is to assist teams in healthcare, drug rehab admissions, and revenue cycle management by cutting down the time spent on these processes. The platform is designed to be user-friendly and compliant, ensuring it’s available round-the-clock for decision-making and care.
Using instantvob® is straightforward. You will need to enter five patient identifiers, and it gives you comprehensive data about the patient’s insurance benefits. You can customize reports for compliance management, and it ensures total security for data and access.
How instantvob® Improves the Verification Process
instantvob® brings several advantages to verify insurance eligibility.
- Real-time response rate: The platform’s ability to provide data in real-time supports quick decisions on treatment and therapy admissions. It helps to enhance census numbers while reducing collection outcomes and denials.
- Boosts admissions: It also boosts admissions significantly and makes sure that insurance payments are received on time. Even when support from the insurance company is unavailable, instantvob® can provide a patient’s active status, deductible, co-pay, and co-insurance information.
- Cloud-based for efficiency: Moreover, the cloud-based tool eliminates the manual elements in the insurance verification process and automates it to make the entire process faster. By providing real-time notifications, instantvob® eliminates the need for manual follow-ups and phone calls. It helps to streamline the process and reduces the administrative burden.
Best Practices for Successful Insurance Eligibility Verification
Managing insurance eligibility verification can be a complex yet necessary task for healthcare providers and payers. The increasing complexity of health insurance plans and the need to verify a patient’s coverage can be time-consuming, causing delays in treatment.
Pre-Visit Verification
Start the process before your patient steps into the office. This practice is known as pre-visit verification. It means checking the patient’s insurance status before their scheduled appointment.3
You can contact the patient’s insurance provider to get their eligibility information in advance. You can also use electronic eligibility verification systems that give you quick access to the patient’s coverage information.
Denial Management
When you try to verify insurance eligibility, and a claim is denied, it’s important to be proactive in resolving the issue. To ensure prompt resolution, having a denial management strategy is essential. This includes reviewing the denied claim, looking for any errors, and filing an appeal if necessary.4
A/R Follow Up & Collections
Once you verify insurance eligibility, follow-up is essential to ensure it is processed in a timely manner. This includes tracking the status of claims and contacting payers when necessary. Payers are often slow to process claims, so A/R follow-up is key to collecting payments quickly. Once A/R follow-up has identified any outstanding or denied claims, collection efforts can begin.
Report Generation
Generating accurate reports is another key aspect of the billing process. Reports allow you to track and monitor your business’s financial performance, as well as identify any areas that need improvement.
Verify Insurance Eligibility with instantvob®
If you or someone you know is struggling to verify insurance eligibility, consider contacting instantvob®. Our mobile-first solution saves healthcare, drug rehab admissions teams, and revenue cycle management teams by providing fast and accurate reimbursement estimates.
Our always-on platform is accurate, easy to use, and compliant. We meet the need for 24/7 decision-making and care. The ability to acquire a patient’s active status, deductible, co-pay, and co-insurance information when insurance company support is unavailable reduces denials, increases admissions dramatically, and helps ensure insurance payments are received promptly.
Contact instantvob® Today
Our mission is to provide quick, easy, and efficient benefits verification to patients, so care providers can focus on receiving the best treatment.
We are tailored specifically for hospitals, substance use facilities, mental health centers, and individual practitioners. So, we understand how to support healthcare providers and patients to make better, more confident treatment decisions.
Reach out to instantvob® today, and we’ll help you verify insurance eligibility.
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