Verifying a patient’s insurance benefits is a vital first step in providing quality care. For decades, it’s been a time-consuming and frustrating task and can result in a claim sent to the payer being denied.
Today, however, there are convenient methods of conducting insurance eligibility verification, including online services. This article shares some helpful tips to streamline your insurance verification process.
Why is It Important to Verify a Patient’s Insurance?
Though it might seem like common sense to confirm insurance coverage before administering patient care, Employee Benefit News reports that health insurance verification is one of the most common medical billing errors.
There are several benefits to conducting an insurance verification prior to providing healthcare, including these three:
1. Improve patient satisfaction. No one likes receiving a surprise bill, and 90% of patients have expressed that they want to know what they’ll be paying for an office visit or procedure upfront.
2. Reduce claim denials. If you’ve taken steps to verify healthcare coverage, you’ll inevitably have fewer claims rejected. Keep in mind that a patient’s information and industry regulations change, so prior authorization for each visit is prudent.
3. Improve cash flow. Ideally, you want an insurance claim paid promptly and in full. However, denials result in extra steps and take time to sort out. If you don’t confirm member eligibility in advance, you could end up with a pile of claim denials, resulting in your staff chasing down payments and accumulating bad debt.
How Do I Find Out if a Patient Has Insurance?
There are two methods to confirm whether a patient has insurance:
1. Pick up the phone and call the insurance companies.
2. Use an online service to conduct eligibility verification.
Arguably, going online is the preferable solution. Instead of spending countless hours each week on hold, dealing with glitchy IVR systems, and having no guarantee that there’s not an element of human error involved, you can get instant verification by getting prior authorization online.
Systems like Weave can verify health insurance in as little as 10 seconds through either your desktop or a mobile app, making life easier for your staff and your patients.
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What Pertinent Pieces of Information Do You Need When Verifying Insurance Benefits?
There’s a long list of things to remember to ask for when verifying insurance eligibility. The following sections give step-by-step instructions and a complete checklist.
Also, make sure you keep a copy of the patient’s insurance card on file to confirm details as you’re entering them into any insurance verification service software.
Insurance Verification Cheat Sheet
If you are going the phone route, these prompts facilitate the health insurance eligibility verification process.
Step 1: Begin with a friendly greeting and inform the provider that you are calling to check eligibility for one of your patients.
Step 2: After providing the representative with the pertinent patient information, inquire whether the services you need authorization for are covered.
Step 3: If yes, ask if there are any exclusions. If there are, find out the conditions for those exclusions. If there are no exclusions, inquire about the number of patient visits authorized per calendar year and how many have been used thus far.
Step 4: Next, inquire about the patient’s deductibles and copays.
Step 5: Assuming the treatments are authorized, check to see if prior authorization is required.
Step 6: Finally, confirm the Payer ID number.
Note that this cheat sheet does not apply to Medicare Advantage, which has a different process for verifying patient eligibility.
Insurance Verification Checklist
There’s a long list of patient info to confirm proof of healthcare coverage from an insurance provider, including:
- The insurance company name and contact details
- The insurance ID card and, if applicable, the group number
- The name of the person on the insurance card (this could be someone other than your patient)
- Coverage dates for the policy
- Whether the services being provided are covered by insurance
- Whether there are any insurance policy rules or special documentation required for payment
- The patient’s financial responsibility for copays and deductibles
Insurance Verification Software
One of the biggest benefits of insurance verification software is that it can help you save time and dramatically reduce the errors that are fraught in this process. Weave customers have saved an average of 20 hours per week using Weave Insurance Verification.
Verifying health insurance eligibility no longer has to be a headache, and you can feel more secure in claims being paid on time with a system that you can trust. To learn more about Weave, schedule a demo.
What is an Insurance Verification Training Manual?
A training manual will give you a step-by-process that you can use across your organization to verify healthcare coverage.
What is Real-time Insurance Eligibility Verification?
Real-time insurance eligibility verification allows you to confirm patient insurance information with the payer instantly and before their appointment.