Insurance verification and authorization is the first and vital step in the medical billing process. It is very important in accelerating the medical billing process. Insurance verification works to ensure that the patient’s health care benefits cover or not. It is very important to finish insurance verification before a patient receives medical services. To avoid claim denials and patient ineligibility-based refusals, checking insurance eligibility and receiving authorization is essential. Denied claims are a tremendous loss of time and money for any practice. Simple errors in patient information can head to billing denials. It occurs because physicians have no idea of knowing if a patient is eligible for coverage without checking this information directly with the insurance company. Lack of proper eligibility verification can result in denial claims, delayed payments, patient ineligibility-based rejections, need for resubmitting claims, patient dissatisfaction. It is very important to validate the patient’s insurance details with a suitable insurance payer.
The process of obtaining insurance authorization of a patient’s Medical, Medicaid and Medicare are a necessity to ensure that the patient has coverage. Healthcare practitioners also provide complete support to obtain pre-certification and/or prior authorizations. Insurance verification and authorization process includes:
- Receiving patient schedules from the hospital or clinic via email or fax
- Entering or updating demographic information and prior authorizations for patient visits
- Verifying patient information with the insurance carrier (verification of benefits, co-payments, deductibles, patient policy, effective date, co-insurance, plan and coverage details, exclusions, etc.)
- Verifying insurance coverage on all primary and secondary payers
- Obtaining authorization for medical treatment from the appropriate source
- Communicating with the patient for additional information necessary to process the application
- Processing all information received and updating the billing system with eligibility and verification details
- Contacting insurance agencies on your behalf for obtaining approval for the request
Outsourcing of insurance verification and authorization allows medical practitioners to focus on providing quality healthcare service to their patients. It can help them to get the support from an insurance verification specialist at each stage of the process. It is very beneficial for medical practitioners to save time and energy by outsourcing the work to the medical billing company. AccQdata has been offering insurance Eligibility verification/ Authorization service so its clients for more than a decade. The service is called as cycle management or a ‘stand-alone’ service.