Eligibility verification

Eligibility verification is important to ensure accurate and timely receipt of information regarding insurance coverage and determining the patient’s responsibility to pay for healthcare services. To receive payments for the services rendered, healthcare providers need to verify each patient’s eligibility and benefits before the patient’s visit. Even then, many healthcare providers do not pay the needed attention to the eligibility and verification process. Unfortunately, it is one of the most neglected processes in the revenue cycle chain. Accurate and timely determination of the patient’s eligibility provides healthcare providers with a clear view of the patient’s coverage, out-of-network benefits, and accurate insurance information. Incorrect insurance information could result in delayed payment at best or denial at worst. Performing eligibility verification helps healthcare providers submit clean claims. It avoids claim re-submission, reduces demographic or eligibility related rejections and denials, increases upfront collections; leading to improved patient satisfaction.

Key benefits

  • We receive patient schedule from the healthcare provider’s hospital or clinic and perform entry of patient demographic information.
  • We then verify primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible, and co-insurance information, and benefits information.
  • We contact the patient, in case of missing or invalid information.

Prior Authorization

  • Determine prior authorization requirements
  • Prepare and submit paperwork to the payer
  • Follow-up on submitted prior-authorization requests
  • Notify the client for any issue with the authorization request
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Our value proposition

  • We identify accounts that need to follow up with insurance companies
  • Our AR analysts research the claims denied by the carriers, rejections received from the clearinghouse, and low payments by the carriers
  • The AR follow up team is provided with the analyses claim information for follow up with the insurance company and determination of claim status
  • Depending on the input from the follow-up team, the AR analysts conduct an analysis and compile all claim details so that corrective action can be initiated for non-payment
  • Necessary action is planned and executed to collect the outstanding AR