Eligibility Verification and its benefits
What is Eligibility Verification?
Eligibility verification is the process of confirming a patient's insurance coverage and benefits before providing medical services. It involves checking whether a patient's insurance policy is active, what services are covered, and what the patient's financial responsibilities (like copayments, deductibles, and coinsurance).
What is the Importance about Eligibility Verification?
Eligibility verification helps avoid denied claims, ensures accurate billing, informs patients of their financial responsibilities, and ultimately contributes to the financial health of the medical practice.
Key Aspect of Eligibility Verification
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Insurance Coverage Status: Ensures that the patient's insurance plan is active and valid on the date of service.
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Benefit Details: Confirms what specific services are covered under the patient’s plan, including any limitations or exclusions.
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Patient Financial Responsibility: Identifies the patient’s obligations, such as copays, deductibles, and out-of-pocket maximums, so they can be informed ahead of time.
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Provider Network Status: Checks if the healthcare provider is within the insurance network, which affects the patient's coverage and costs.
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Pre-Authorization Requirements: Determines if any services require prior authorization or referrals from the insurance company.
Process of Eligibility Verification at 855mybilly
Data Collection
Gather the patient’s insurance details, including insurance card information, ID number, group number, and personal identification details.
Verification
Contact the insurance provider through their online portal, phone, or via third-party services to confirm the patient’s coverage.
Documentation
Record the verified information in the patient’s medical records and billing system for future reference.