What are the Important Steps in Insurance Eligibility Verification?

Insurance companies or payers as they are commonly known in the healthcare industry are responsible for paying a patient’s medical bill. The revenue model of healthcare insurance providers circles around evaluating the medical condition of a patient and reviewing the treatment procedures administered to them, by care providers.

Healthcare billing service providers need to be attentive and specific when drafting an insurance claim for a patient. By verifying the terms of coverage of a healthcare plan, care providers can overcome one of the most common reasons behind a denied claim, which is, eligibility check. This is why insurance eligibility verification comes to play a very important role. 

The Need to Verify Insurance Eligibility

 Healthcare insurance providers have a wide variety of care plans, each one customized to cover specific ailments. They do not cover the entire cost of the treatment in most cases. With specialized services such as remote patient monitoring or physical therapy, care providers have alternate modes of treatment to stabilize the health of a patient. 

They can always choose the option that is covered by the insurance plan of the patient. This almost assures them of successful reimbursement once the claim is submitted. So, by knowing what services are covered by the patient’s insurance company, care providers stand to strengthen their revenue influx. 

What Does Insurance Verification Entail?

Capture Patient Details: The insurance eligibility verification process begins with the collection of patient information. The insurance name, ID, policy effective dates, relationship of the dependant to the patient and limitations of the policy are some of the details that are verified by healthcare providers.

Obtain Copy of Patient’s Insurance Card: Care facilities ask for an updated image of the patient’s insurance card. These images help care providers verify patient information. This can be handy in cases where patient information has been entered incorrectly. Medical billers cross-check the patient ID number from the patient’s insurance card at the time of claims submission. 

Contact Insurance Company: Providers contact the insurance company that covers the patient by making phone calls or reaching out to them through billing systems designed to verify patient eligibility data. Despite seeking a copy of the patient’s insurance card, care providers adopt this step to account for changes that can be made to the patient’s insurance policy after the insurance card has been issued.    

Record Treatment Information: Another critical juncture where providers need to perform an eligibility check is when the treatment is initiated. More often than not, the patient’s medical condition may require specific procedures that may not be covered by their insurance plan. In such cases, providers can only refer to the treatment information that has been transcribed and recorded thoroughly.  

Follow Up: Although this is a step utilized by providers only when the need arises, following up with a patient is an important part of the insurance eligibility verification process. The follow-up process is mostly necessary to give the patient a heads up about treatment services that their medical condition requires, but is not covered by their insurance plan.

The insurance eligibility verification process helps care providers reduce the possibility of being stranded with denied claims. It does so by telling them upfront, the care procedures that a patient’s insurance plan covers.