Insurance Verification checklist providers should follow

Did you know a large number of claims get denied due to lack of eligibility verification? If you are a practice owner looking for ways to improve income and productivity, then checking patient insurance eligibility is extremely important. There are several different ways in which eligibility checks can be performed. Only when you have a solid verification process in place, you can raise the overall bottom line of your practice.

Here is a checklist that the office staff can follow for effective insurance verification:

  • It is very important for the front desk staff to ask the right questions during the verification process. They need to enter information from the patient’s card or ask for information from the insurance company. Some of the details that each patient’s EMR should include are- name of the insured, effective date of the policy, end date of the policy, insurance ID and group number, insurance name, is coverage fully active, does the plan cover the procedure, diagnosis and so on.
  • The next step should involve getting a copy of the patient’s insurance card. The staff should ask for a copy of the new insurance information from the patients even if the patients state that their insurance hasn’t changed. You will have informational backup if the staff gets updated image of both sides of the insurance card. The ID numbers should be double checked by the medical billers against the cards before they send claims.
  • Third step involves contacting the insurance company because information on the cards cannot be taken at face value. It is important to cross check because even a few weeks after the card has been issued, the insurance coverage may have changed or discontinued.
  • The staff then needs to start recording the accurate information. There is a lot of precision required in transcribing information into patient records. This information will be the foundation of the medical claim to be submitted by the billers so even a single errors can lead to denials.

Lastly, following up with patients is very important. They need to be contacted if there is any question or concern. Staff can use the patient portal for informing patients but a phone call is also effective in letting them know about co-pays and other issues. If the patients are informed early about their out-of-pocket expenses, your practice will increase the chances of collecting funds.

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