Home / Blog

How Eligibility Verification acts as an effective denial management source?

Share Button

Providers lose thousands of dollars every year when services provided by them are denied as non covered services by the patient’s medical insurance company. Usually the providers get these denials anywhere between 15-30 days after the services were provided. Now, they end up billing the patient after 30 + days and also need to spend more time, money & resources to collect it. If they are not successful in collecting the money, then it will be usually moved to a collection agency. This inefficiency can be erased or reduced by Eligibility Verification Process.

It is common for an individual or an employer to change their insurance plans periodically for convenience, better services or for cost reasons. These frequent changes make it important for the providers to have all the latest coverage information. Hence eligibility verification process has become an important step in quicker reimbursement. Eligibility verification reduces and in many cases eliminates denials. Eligibility verification helps to increase provider revenues and eliminates uncollectible.

Benefits and eligibility verification helps the provider office to determine co-pay, deductible and out of pockets expenses prior to providing the services. This helps them to collect the co-pays up front during patient visits to their provider’s office. It also helps reduce claim rejections and reduces billing costs from incorrect data errors. Accurate data is the crucial first step to effective revenue cycle management. An efficient eligibility verification process clearly simplifies patient registration process, reduces claims rejections and increases collections.

Eligibility and benefits verification helps to submit high percentage of clean claims to the payers. This helps in quicker reimbursements and timely patient billing. Claims denied for no coverage and non covered services can be reduced significantly.  Eligibility and benefits verification can be done in various methods like physically calling the insurance companies, using payer’s online portals and by using private vendor verification tools. Advanced technologies help us to get real time verification done within seconds. This helps to register the patients quickly in the provider’s office and greatly increases patients office visit experience.

Eligibility and benefits verification usually provides various information including but not limited to Patient/Subscriber name, Effective date of coverage, Group Name, Plan Name, Co-Payment, Deductible, Co-Insurance, Authorization, Referral requirements and more. Eligibility verification can also help to determine patient’s primary and secondary coverage. Online verifications help reduce medical staff time spent on calling, faxing and researching. It also increases overall cash collections and reimbursements for the healthcare providers.

Eligibility verification helps in getting the claims paid accurately and quickly. It ensures fewer denials and increase cash flow for the practice. It helps to lower claims billing cost and increases financial bottom line for the practices. Accurate verifications reduce denials drastically and also help to reduce AR days.  Many online verification services help to load the data directly into the practice billing software. Verification process helps to reduce errors and denials thus helping to manage the practice revenue efficiently. Verification plays a very important step in denial and revenue cycle management of any healthcare practice.