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Healthcare Insurance Eligibility Verification

Insurance Eligibility Verification is extra decisive today than always with the advent of the Affordable Care Act. With ACA in place, the patient can have insurance one month and not pay their premium following months.

Qualified health plans are obligatory to pay all claims for services provided in the first month of the grace period (eligibility). Carriers will pay out claims in the second or third months, at which point the patient must pay the provider for the services already provided or pay their insurance premium.

If the patient cannot manage to pay for the payment for their premium, then any physician claims pending during this second and third month will go unpaid causing an increase in bad debt collections.

The protocol of confirming the eligibility of a patient for the services that are being provided could minimize the denials to a greater extent. Denied claims due to non-coverage, out-of-network, unauthorized patient procedures or visits can incur a major loss in revenue and should never be taken frivolously.

Eligibility verification process can be consummated through a call to the Insurance companies, websites (payer or EDI) or through online software at present integrated in many EHRs.

Through accurate eligibility authentication, revenue cycle can be improved by reducing the number of rejections. There are missed opportunities to secure payment and increased staff time when the patient’s insurance eligibility is not validated before the service is rendered.

Personal information such as phone number, address and insurance coverage information is to be reorganized. Therefore, always verify the information on file is current and up to date.

CodeMatrix has been offering eligibility verification services to its clients very effectively. The service is offered as part of the full revenue cycle management or as a ‘stand-alone’ service when required.

CodeMatrix Offers Service at Two Levels –

At the first level being a basic insurance eligibility verification that gets coverage details of the patient in addition to the co-pays and deductibles.

The second level is to a large extent more in-depth and involves the gathering of CPT specific eligibility with annual max or lifetime limits and authorizations when obligatory.

Insurance eligibility verification when leveraged with our billing and coding services will increase clean claims, improve cash flow, minimize bad debt and increase patient satisfaction.

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