Insurance Eligibility & Benefits Verification

Why Insurance Eligibility & Verification

Insurance Eligibility & Benefits verification is one of the top most integral part in the Medical Billing process. As per the industry research, most of the insurance denials or delays in processing the claims occur due to missed or improper coverage information.

Insurance companies frequently make policy changes and updates in their health plans. If the provider or the billing office is not aware of these changes, this may directly impact the practice cash flow. Therefore, verifying patient’s Eligibility & Benefits becomes inevitable part in the Medical billing cycle.

We at Ephysician Healthcare Solutions have built a template for verifying and updating the members benefits and Eligibility.

Insurance Eligibility & Benefits Verification process at EPhysician Healthcare Solutions

We receive the patient schedule through our secured FTP or we pull the patient’s schedule from the EMR system

We call the payers directly/IVR or verify the eligibility & benefits through authorized online insurance portals and obtain the patient’s eligibility information like

Member ID number & Group ID number

Coverage effective/Termination dates

Primary & Secondary coverage details

Co-pay information

If policy termed, other insurance coverage details and a detailed list of benefits depending on the patient’s plan.

The eligibility & benefits information is directly uploaded in the respective patient account in the billing system. A copy of the report will be e-mailed to the client before the patient visit the doctor office.

Our insurance verification team follow a standard questionnaire while verifying the patient’s eligibility & benefits. This questionnaire has been built in a way to zero out any rejections from the payers and ensure all the claims sent out reaches the payer as a Clean Claim resulting in maximizing the cash flow of the practice