As a dental practitioner, you know that patient health insurance eligibility verification is key to building a clean claim reputation. An insurance company is less likely to deny or underpay a claim if your practice follows the appropriate insurance verification process. It’s a win-win for everyone.
The best way to verify patient insurance efficiently with a provider is by incorporating automated insurance verification software into your current dental office suite. You can streamline your processes and let your medical billing department focus on invoicing and claim submission rather than spending time on hold with each insurance company.
How Often Should the Patient’s Insurance Coverage Be Verified?
Patient insurance coverage can frequently shift as patient eligibility adjusts with changing jobs, unemployment, or personal finance changes. Because even an existing patient may switch their insurance carrier, healthcare providers should request patient insurance eligibility verification at several stages, including:
- When a patient schedules an appointment
- When you confirm the patient’s appointment 2-3 days ahead of time
- When the patient checks in for their appointment
- After the appointment to prove a clean claim in the event of a claim denial
- During a monthly eligibility check to update your patient information files
Because many patients’ eligibility can change, healthcare providers should verify patient coverage regularly to ensure their medical billing services department can seek remitment from the appropriate payer.
What Are Insurance Verification Systems?
Because many patients don’t fully understand their patient benefits, their healthcare provider must verify health insurance eligibility. You need to ensure the patient coverage pays for certain procedures and get prior authorization from the insurance company.
Prior authorization for procedures from the patient’s insurance carrier helps prevent claim denial, saving the practice thousands of dollars in medical billing work hours.
Many patient insurance verification systems exist to streamline the insurance eligibility verification process. Essential features of any good insurance verification system include:
- Interfacing with patient care management systems and medical billing software
- Automatic and manual updates of patient health insurance information
- Chronological logging of every patient benefits verification on record, rather than storing only the last patient insurance eligibility verification
- Real-time eligibility verification for regular appointments and emergency admittance
- Automatic updating and delivery of essential patient information, including health plan, benefits policy information, patient satisfaction of the waiting period, secondary insurance, etc.
Other features that improve the insurance verification process include generating medical billing estimates for the insurance provider’s responsibility and patient deductible, built-in prior authorization management, and a patient eligibility verification report for office and medical billing management.
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How To Verify Patient Insurance Eligibility Using Four Methods
In the insurance verification process, your office likely employs a series of steps to determine a patient’s eligibility and insurance plan coverage. Typically, those steps include:
- Collecting the patient’s health insurance information, including the insurance provider, insurance plan policy number, and potentially the group number.
- Contacting the insurance company to verify coverage benefits through the healthcare provider contact number or patient care portal.
- Getting pertinent information about the patient insurance coverage limitations, deductible, and specific payer documentation while you have an insurance company representative on the phone.
- Confirming with the patient that the insurance coverage information is correct and repeating the insurance verification process if you need to correct any patient insurance information.
You can perform an eligibility check for a patient’s insurance coverage in four main ways.
Insurance Website Verification
You can go directly to the insurance company’s website and look for the healthcare portal to complete eligibility verification for the patient’s health plan coverage. Be aware that these provider portals can be slow and outdated, depending on the insurance company.
If your medical billing department already uses a clearinghouse portal to manage multiple payer claim requests, your portal probably already offers health insurance eligibility verification. You can likely run a batch patient eligibility verification for all patients scheduled for an appointment within an upcoming time frame.
Sign up for an automated patient insurance verification service like Weave Insurance Verification. Your private practice medical billing services department spends six hours or more per week on insurance eligibility verification, and it’s much higher for hospitals and other large medical facilities.
Your insurance verification tool will verify your new and existing patient insurance coverage details and coordinate with your appointment schedule. A good automatic verification program offers real-time eligibility verification and reporting so you can address issues with a patient’s health insurance company as soon as you find a problem.
Direct Payer Contact Verification
You may also call the payer directly to verify patient benefits eligibility. You will most likely utilize the automated voice response system for insurance eligibility verification. While you can request to speak to a human representative, hold times are long and can eat up hours of labor in your medical billing department.
While there are many ways to verify patient insurance eligibility, a real-time automated insurance eligibility verification program will save your office hours of labor in your medical billing services department. As a healthcare provider, you know the benefits of verifying a patient’s insurance coverage and getting prior authorization to prevent claim denial.
At Weave, we help healthcare professionals streamline their office operations and patient insurance eligibility verification with our multi-service platform. Our software offers missed call texts, automated appointment confirmation, health insurance claim management, medical billing invoicing, and more. Schedule a demo or call us today at 866-308-2039 to see how to verify patient insurance with Weave.
What is real-time insurance eligibility verification?
With automated insurance eligibility verification, your practice can save hours every week normally spent on the phone in the insurance verification process with health insurance providers. Using your office’s dental software and integrating with real-time insurance eligibility verification lets your office create an efficient process to improve patient satisfaction.
Why is it important to verify a patient’s insurance?
Insurance coverage verification is a complex series of steps that a healthcare provider must complete at several stages of serving a patient. Whether for a new or existing patient, you must verify insurance coverage and get authorization for procedures to reduce instances of claim denials. The insurance verification process can take hours to complete each week, which is why automation is essential.