Eligibility verification is the base of the medical billing and it has the absolute potential to decide the fate of a claim. At times we don’t give adequate significance for the insurance eligibility verification. We have an impression that certain claims don’t require insurance eligibility verification and we fail to foresee the consequences of it. To avoid this troublesome situation, we need to adhere to a better and streamlined process flow which will initiate the insurance eligibility verification irrespective of whether it is an ordinary health plan.

Eligibility verification process:

  • Receiving Schedules of patients via EDI, email or fax or check them every day in the appointment scheduling software.
  • Verify patients’ insurance coverage with primary and secondary payers by making calls to the payers and checking through their authorized online insurance portals.
  • Contacting patients for additional information, when required.
  • Update the medical billing system with eligibility and verification details such as member ID, group ID, coverage period, co-pay, Deductible and co-insurance information and other code-level benefits information including max limits allowed.
  • Informing the client immediately, in case of any issues in the verification process.