Eligibility Verification
The process of verifying a patient’s eligibility involves figuring out whether the procedure that was billed for their insurance coverage matches the one that was actually performed. This can occur for a variety of reasons, such as the patient being billed for a different procedure to a different physician, or the incorrect procedure being claimed as covered by their insurance policy.
If you, like most people, find it difficult to obtain the information you require from your insurance company, we have experience dealing with them and have trained a dedicated team that understands health insurance plans and benefits. We are going to verify your eligibility so you know what to expect when you arrive for your visit.
Our Eligibility Verification Process:
Verifying eligibility is a crucial stage in the complete medical billing process. It enables the supplier to guarantee payment for the services delivered. Providers might not be compensated if eligibility isn't verified because the insurance company can't determine the patient's benefits and/or coverage.
Verifying eligibility helps healthcare providers submit accurate claims. By preventing claim resubmission, it lowers eligibility-related rejects and denials in RCM, boosts collections, and enhances patient satisfaction. .
We get our process through the work log, EDI logs, fax, emails, and FTP files. The patient's ID number, group ID, coverage duration, co-pay, deductible, insurance eligibility verification procedure, and benefit details are then double-checked for primary and secondary coverage.
We use web portals or phone calls to get in touch with the payer. We get in touch with the patient if any information is incomplete or inaccurate.
Eligibility verification is crucial since it verifies the patient's insurance status and the extent to which the procedure is covered by their plan. The amount of their bill that they will be responsible for paying is also determined using it.
Why Choose CFT’s Medical Billing Services?
Real-Time Eligibility Checking
Software programs with integrated deductible balances, co-pay and co-insurance, and real-time insurance eligibility. Your practice may effortlessly verify insurance coverage in real-time with the help of well-placed icons at every touchpoint.
Batch Eligibility for Patients on Schedule
The eligibility verification process no longer requires human labor thanks to the PrognoCIS Batch Eligibility function. Every booked patient appointment involves an automatic eligibility verification. Just plan your auto-check procedures so that the front desk can proactively ask the patient for the information they need.
Real-Time Patient Demographic Validations and Updates
Verify, contrast, flag, and update demographic information with insurance records. Look for any spelling, address, or subscriber information errors that might be important for patient collections. Get demographic insights on important patient validation data so you may make better decisions about your practice.
Scheduled Automated Eligibility Check
With the use of an accessible eligibility response button, automatically schedule eligibility checks at different care and billing touch points
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