How does Insurance Verification Specialist work?

Before you provide care, it's important to affirm how a patient will pay for your administrations. In situations where patients are secured by an insurance plan, it's similarly vital to confirm their insurance eligibility before you provide any care. Neglecting to do could leave you with an unpaid claim by the insurance agency or a patient not able to pay their bill in an opportune way.

Here is the workflow that goes into verifying patients old and new, and how it can help you sustain the medical practice you are into: 

For New Patients  

At the point when a prospective patient calls to make an appointment, we first make an effort to talk about payment and insurance coverage with them. Providing new patient with paperwork preceding a first appointment is an effective business practice that can spare you and your patient's time and money. The paperwork includes forms designed particularly to gathering insurance data, and in addition statements regarding payment obligation. It's relevant to outline the payment options you offer and require the patient to confirm who is in charge of their bill, beside any healthcare coverage they have.


With a specific end goal to affirm insurance eligibility, our verification team asks for information such as:  

  • Patient's name and date of birth  
  • Name of the primary insured  
  • Social Security number of primary insured  
  • Insurance Provider  
  • ID number  
  • Group number  
  • Contact information of the insurance agency including telephone number, website and address for submitting claims 

Once we get the insurance data on our hand, we then contact the healthcare provider to check the following information:  

  1. Patient is in fact covered under a healthcare plan  
  2. Effective Dates of Insurance coverage  
  3. If coverage is within a demographic network or outside of it  
  4. Service(s) you are seeing the patient for are covered. Do they require prior authorization or potentially a referral by a primary care physician? 
  5. Amount of co-pay for administrations, if any 
  6. Checking the Deductible amount, is the deductible have been met for the year? 


When all of the above perquisites are taken care of, and when the patient comes for his appointment with the doctor, all you need to do is make a copy of their photo ID and insurance card and collect any applicable co-pays. 

For Returning Patients  

It's likewise critical to keep your returning patients' records up-to-date. Personal data, similar to address, contact information and amount of coverage can change over a brief timeframe, so dependably getting it verified through outsourced eligibility verification agency can lessen the financial burden. If a returning patient shows an adjustment in insurance, we follow the same procedure to verify the insurance benefits and prior authorization notification, same as the new patients. 

Having efficient management for gathering patient data and confirming insurance verification and eligibility authorization will encourage a streamlined claims and billing process. We have developed sophisticated tools which automate much of the process with pin-point precision in every claims verification request that we handle, providing the doctor’s a healthy revenue cycle at the end of each month. 

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