Revamping Insurance Eligibility Verification Processes

  • Written by Ashley Mark
  • Monday 3rd April 2023
Revamping Insurance Eligibility Verification Processes VLMS Healthcare

Running a medical facility and being a medical practitioner is a challenge. To own a reputed and famed healthcare institution requires various resources and efforts. Getting paid for the services rendered is the right of any physician without delay. However, they usually suffer from unpaid claims and payment rejections for the services rendered. It cannot be practically denied that medical practitioners and facilities are supposed to get payments for the services they have offered to patients.

If any patient is taking services through insurance policy coverage and benefits, the insurance can anytime deny the claims by not paying if the policy clearly mentions about the service is not covered. This type of situation clearly highlights the importance of insurance eligibility and benefit verification. 

Why insurance eligibility verification is important?

Insurance eligibility is an essential function of any healthcare system. It helps in identifying insurance coverage and benefits before a patient visits and any medical procedure. It also helps in revenue cycle management cycle services to speed up billing process and also secured reimbursement from insurance. If in case, the medical procedure is not covered under an insurance policy, then the physician has to create a plan for patients in order to avoid payment loss. 

The importance of insurance eligibility and benefit verification cannot be ignored now. It guarantees results only when plans and strategies are put in the right place. Below mentioned steps can help in revamping insurance eligibility verification process. 

A complete process of insurance eligibility verification process in place is the very first step for an efficient verification process.

  • Date of insurance policy starting and disposing
  • Important details of insurance coverage like coverage amount, services exhausted procedures covered, and applicable patient responsibility.
  • Beneficiary and dependent information
  • Provider and practice in tie-up with the insurance
  • Copay, deductibles, and co-insurance details
  • Prior authorization and referrals needs of procedures
  • Policy limitation and debarring
  • Documentation necessary for claim processing if anything exceptional

Updated insurance card copy

Taking an updated insurance card copy is the initial process, but is very crucial. This helps in ensuring correct insurance-related information and coverage verification.  Make sure that there is always an updated insurance card copy in electronic medical records for any time of reference. 

Verification process

Process of insurance eligibility verification is not very smooth. It requires a team of experts and skilled individual who never fails in taking minor details also. Missing out on a minor detail can lead to repetition of the whole process. There are various ways to contact insurance companies for insurance eligibility verification.

  • Integrated EMR and Billing system utilization to contact insurance and verify
  • Phone calls using the provider's tollfree number
  • Setting up an automated eligibility verification system

Collection of accurate data

During insurance eligibility verification it is critical to follow the sharp steps and get the most without following up again. Updating the EMR and billing system from time to time with the changes in insurance details is imperative.

An experienced and skilled workforce with all the knowledge about insurance eligibility verification is a gem here. 

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