Eligibility and Benefit Verification

Eligibility and Benefit Verification

For most of the cases, practice revenue burns because of issues related to insurance coverage and member benefits. Many claims are denied because of the not verified eligibility and benefit or the service or patients not covered by the plan providers. Unfortunately, it is one of the most neglected processes in the revenue cycle chain.

In this way, a huge revenue is lost and can be saved if the health care providers establish an insurance verification process or get eligibility and benefit verification services from a professional company like Advantage Medical Billing.

Our eligibility and benefit verification services can reduce different types of denials, making billing practices more efficient and increasing your overall bottom line revenue. We ensure the patient benefit and insurance eligibility is verified before the clinical services are provided.

In contrast, Ineffective eligibility and benefits verification and/or prior authorization processes can result in increased claim denials, delayed payments, additional effort on rework, delays in patient access to care, decreased patient satisfaction, and non-payment of claims.

Our team members will do the following steps as a part of effective and productive verification processes:

  • Receive patient schedule from the healthcare provider’s office – hospital and/or clinic
  • Perform entry of patient demographic information
  • Verify coverage of benefits with the patient’s primary and secondary payers:
    – Coverage – whether the patient has valid coverage on the date of service
    – Benefit options – patient responsibility for co-pays, co-insurance, and deductibles
  • Where required, the team will initiate prior authorization requests and obtain approval for the treatment.
  • Update the service provider’s revenue cycle system or the practice management system with the details obtained from the payers.

Our services ensure lesser numbers of claim denials and cash flow is accelerated through a robust eligibility and verification process. Our staff check member eligibility with an insurance card and also view detailed benefits information.

Advantage Medical Billing also confirm all details such as group number, group name plan, current effective dates, co-payment and co-insurance, deductible (original and remaining amounts), out of pocket limitations, Pre-authorization indicators and contacts, search benefits by category, get a copy of the digital ID card, check coverage limits and therapy accumulators, verify the care provider’s network and tier status for the member’s plan, view cost-share amounts and balances, member ID cards verification and more.

Hence, taking eligibility and benefit verification to a next level.