A flawless claims processing procedure is essential in the fast-paced insurance industry, which may make or break the client experience. Verifying insurance eligibility is a crucial stage at the core of this effective procedure. This essential component ensures that the wheels of claims processing move properly, ensuring the integrity and correctness of policyholder data and coverage specifics.
Insurance eligibility verification is vital to accelerating valid claims, preventing fraud, and ultimately raising customer happiness. In this post, we will delve into the significance of insurance eligibility verification, revealing how this crucial procedure lays the way for a hassle-free claims experience and deepens the relationship between the insurance provider and policyholder.
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Why Does It Matter to Verify a Patient’s Eligibility?
Besides the core job of treating a patient, it is also the responsibility of healthcare providers to verify the insurance eligibility of their patients. Healthcare providers often outsource their insurance eligibility verification services to someone knowledgeable and experienced. It is done to ensure the verification is handled with utmost perfection without any errors or mistakes.
But what is the need for verification, and why does it matter so much? Below are the reasons why healthcare providers must go through insurance eligibility verification.
1. Profitability
If the insurance eligibility verification is done in advance, there will be fewer claim rejections. With a proper and accurate verification system, the healthcare provider will have clean claim submissions and fewer chances of denial, which will help them to maintain their cash and revenue.
2. Enhanced RCM
Any healthcare system must prioritize revenue cycle management. RCM is a lengthy process that involves adding patients to the system, updating information, and verifying eligibility for claim submissions.
If the eligibility verification is done regularly and on time, the RCM system will never fail and thus increase the healthcare system’s overall productivity.
3. Patient Satisfaction
No patient will like to be involved with a healthcare system that doesn’t inform about the settlement and claim chances before the start of the procedure. For instance, if a policyholder has to undergo dental treatment, it becomes the responsibility of the dental clinic to get the patient’s dental insurance eligibility verification done.
By doing so, the dental clinic will know whether the patient is eligible, which will be communicated well in advance. Such advanced communications build trust between the system and the policyholder, thus, making them happy and satisfied.
When Should Healthcare Providers Do the Verification?
The best and most efficient way to do adequate insurance eligibility verification is before the start of any medical procedure. The patients require a prior-authorization or approval to undergo medical treatment. If not done initially, it can result in claim denials or late payments, eventually hampering the RCM.
How to Do Insurance Eligibility Verification?
You can follow these below-mentioned steps to ensure your RCM is not affected at any point in time because of insurance eligibility verification:
1. Prepare a Checklist
The verification person should prepare a checklist for asking relevant questions during verification. These can include – name, insurance ID, contact details, insurance company’s name, policy validity date, services covered, coverage status, and if any pre-authorization is needed.
2. Get a Copy of Insurance ID
Your team can only verify if they have the insurance ID; therefore, the verifying person should always take the insurance ID copy from the policyholder.
3. Speak with the Insurance Provider
After collecting the insurance card, contact the insurance provider to verify the details. It is done to ensure there has been no recent change in the insurance coverage.
4. Detailed Documentation
To get a claim approved, it is necessary to document everything in detail. The smallest mistakes or missing details can lead to claim rejection.
5. Follow-up with Patients
Always keep the patient’s details in place to call in case any doubts or clarifications are needed during the verification process.
Final Thoughts
The need for seamless claims processing is becoming clearer as insurance firms continue to adopt technological developments and focus on customer-centric strategies. Insurance eligibility verification stands as the gatekeeper of this efficiency, ensuring that only valid claims are swiftly processed while upholding the integrity of the insurance system. By streamlining the claims journey and fostering trust between insurers and policyholders, insurance eligibility verification is crucial in pursuing exceptional customer experiences.
