Eligibility Verification Services
Eligibility and insurance verification is vital to ensuring accurate and timely receipt of information regarding insurance coverage, and determining the patient’s responsibility to pay for healthcare services. Even then, many healthcare providers do not pay the needed attention to eligibility and verification process. Accurate and timely determination of the patient’s eligibility provides healthcare providers a clear view on 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, reduce demographic or eligibility related rejections and denials, increase upfront collections; leading to improved patient satisfaction. Also, verifying authorization requirement before the service avoids denials, and contributes to increase in collections. Leverage Eligibility Verification and Prior Authorization services to optimize your revenue cycle and improve collections.
Eligibility and Benefits Verification Services
- We receive our workflow through the patient scheduling system, EDI, Fax, emails, and FTP files
- We then verify primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible and co-insurance information, and benefit information.
- We use the best channel (call or web) to connect with the payer
- We contact the patient, in case of missing or invalid information
- We assess automated eligibility verification using our RPA tools
Hybrid IMS Value Proposition for Eligibility Verification Services
- Optimize cash flow
- Reduce patient related denials
- Avoid rejection of claims by payers due to inaccurate or incomplete information
- Identify the patient’s responsibility upfront
- Improve patient satisfaction