instantVOB’s® cutting-edge coverage discovery software can help you instantly identify and verify patients’ insurance. Learn more here.
Coverage discovery is the process of finding out if someone is eligible for insurance coverage. It helps people understand what expenses their insurance will cover in the long run and what they must pay themselves. In this way, it helps patients plan their medical care and avoid unexpected costs.1
In the United States, approximately 10.2% of people were without insurance in 2021, and the amount of uncompensated care for uninsured individuals reached $35 billion.
With instantVOB®, you will learn about coverage discovery, the process before healthcare providers see their patients, challenges, and identifying verification. Knowing more about coverage discovery can take time and effort.
So, it is essential to determine how coverage discovery works so you can be more prepared during the process.
Coverage discovery helps healthcare providers find out if patients have health insurance coverage. Here is what it looks like when it is done before providing any care to the patient:
To start the process, patients provide their personal information. This may include the following:
They may also need to share their insurance policy information in some cases. This includes the insurance provider’s name, policy number, and group number. This information helps the healthcare provider initiate the coverage discovery process.
Once the patient’s information is collected, the healthcare provider verifies the insurance details. They confirm if the insurance policy is active and valid. This step ensures that the patient’s insurance information is accurate and up-to-date.
After verification, the healthcare provider checks the patient’s eligibility for insurance coverage. They examine the terms and conditions of the insurance policy.
The aim is to determine if the proposed treatment or procedure is covered. This step helps understand the scope of coverage and any limitations that may apply.
If the treatment requires pre-authorization, the healthcare provider submits a request for approval. They provide relevant medical documentation and explain why the treatment is necessary. The insurance company reviews the request and determines if it meets its criteria for coverage.
There are many other steps to the coverage discovery process that healthcare providers should consider. The additional steps to the process include the following:
After the pre-authorization request, the insurance company informs about the coverage decision. If the treatment is approved, the patient receives confirmation of insurance coverage. This confirmation includes details about the coverage limits, co-pays, and deductibles.
The healthcare provider communicates the insurance coverage details to the patient. They explain the extent of coverage, financial obligations, and any additional requirements. This step ensures that the patient understands their insurance benefits and any expenses.
With insurance coverage confirmed, the patient can proceed with the recommended treatment. The healthcare providers perform the necessary medical interventions. During this process, they should keep in mind the coverage limitations.
After the treatment, the healthcare provider submits a claim to the insurance company. They include all relevant documentation, such as medical records, invoices, and receipts. The insurance company processes the claim and reimburses payment after review.
The patient is responsible for paying any co-pays or expenses not covered by insurance. They receive a bill or statement from the healthcare provider for their portion of the costs. The patient should review the bill to ensure accuracy and address any discrepancies or questions.
Healthcare providers face challenges when it comes to insurance coverage and reimbursement. Below are some important points to consider in this regard:
Coverage discovery plays a vital role in reducing bad debts. It does so by proactively identifying any available insurance coverage for patients. By identifying coverage, healthcare providers can initiate billing procedures for unpaid accounts.
This way, they can ensure that claims are submitted accurately and on time. This increases the likelihood of reimbursement, reducing the occurrence of bad debts.
Many patients may not be aware of all the insurance coverage they possess. Coverage discovery helps uncover these hidden insurance coverages. It does so by thoroughly reviewing patients’ insurance information and eligibility.
Determining the order of insurance coverage is critical for accurate billing and reimbursement. Coverage discovery assists healthcare providers in this regard. It analyzes insurance information, including private insurance, Medicaid, and Medicare.
The aim is to determine which insurance should be billed first, second, or third. By identifying this, providers streamline the billing process and avoid delays in reimbursement.
Nearly 30 million Americans do not have health insurance coverage. When coverage is not
By systematically reviewing and verifying insurance information, coverage discovery ensures that all eligible accounts are identified and billed appropriately. This minimizes the number of accounts that go into bad debts. It also helps healthcare providers maintain a healthier financial position.
Coverage discovery plays a crucial role in the healthcare industry by helping patients gain access to healthcare services.
Here is what you need to know:
Modern software solutions have revolutionized the process. They do so by using advanced algorithms and databases to locate insurance plans. Some important points to consider in this regard will be detailed below.
Coverage solutions are designed to locate unknown billable commercial insurance plans. They use advanced algorithms to examine patient information and match it with databases. This helps find insurance plans that providers may not know about.
Coverage discovery software also looks through Medicaid and Medicare databases. This helps determine if patients qualify for government insurance programs. It ensures proper billing and reimbursement for these patients.
Hospitals can use EDI to make coverage discovery faster. EDI helps staff send claims and check eligibility electronically. It allows for secure data exchange between systems, making tasks easier and reducing mistakes.
Healthcare providers must keep careful records. They should have details about their conversations with the insurance company. This may include the date, time, who they spoke with, and what they discussed.
Coverage discovery software relies on proprietary databases. These databases are regularly updated to ensure accuracy. By accessing this data, the software can quickly verify patients’ insurance coverage.
This includes information on their benefits, limitations, and eligibility criteria. Historical information helps identify any changes or updates in coverage over time.
Coverage discovery accurately identifies and verifies insurance coverage. This helps providers streamline the billing and reimbursement process. It results in reduced delays and denials, so providers get paid faster.
There are some challenges or limitations that healthcare providers face. Here are some common obstacles providers encounter in determining insurance coverage:
There are multiple ways that coverage discovery solutions can help overcome the challenges. Here are some ways in which the software helps providers navigate these obstacles:
Coverage discovery software uses simple digital forms to collect patient information accurately. These forms are easy to use and prevent errors. Providers can access and update patient information conveniently. It ensures accurate insurance coverage determination.
This software verifies insurance coverage in real-time. It connects with insurance databases instantly. The aim is to check a patient’s coverage, benefits, deductibles, and copayments. Providers can make informed decisions and avoid billing problems.
The software automates prior authorization management. Providers can submit authorization requests electronically, eliminating manual paperwork. The software tracks the status of authorizations, ensuring timely approvals and preventing delays.
Coverage discovery software seamlessly integrates with electronic data interchange (EDI) systems. This allows efficient communication with insurance companies. Providers can submit claims electronically, check eligibility, and receive prompt responses. Integration minimizes errors and delays.
Coverage discovery software offers comprehensive reporting and analytics. These insights help improve workflows and make informed decisions for better insurance verification.
Providers can generate reports on the following:
instantVOB® stands out as a leading coverage discovery platform, offering exceptional benefits. We integrate seamlessly with existing systems. The platform is user-friendly, making it simple for providers to use without needing extra training.
With instantVOB®, providers can instantly check insurance coverage and eligibility. The platform connects to insurance databases. In this way, it provides access to coverage details, benefits, copayments, and deductibles.
instantVOB® has a wide-ranging coverage database. Providers can quickly search and verify various insurance coverages instantly.
We also utilize platform checks to claim for errors before submission. This minimizes claim denials and reduces the need for error correction. Providers can optimize reimbursement and improve revenue cycle management.
instantVOB® offers customizable reporting and analytics. Providers can generate detailed reports on coverage verification, claim status, and denial rates. These insights help improve processes.
instantVOB® prioritizes data security and complies with regulations like HIPAA. Providers can trust that patient information and insurance data are protected.
instantVOB® operates on a reliable platform hosted on AWS (Amazon Web Services). This means that our system is robust and easily accessible whenever you need it.
We prioritize uptime and reliability, so you can have peace of mind 24/7. If you or a loved one are interested in coverage discovery, consider instantVOB® today. Reach out to us today for more information.
