Authorizations and Eligibility

One of the challenges practices face is the incorrect capture of insurance information. This can happen for many reasons. First, the patient may supply the wrong or outdated information. Second, the practice could type the information in incorrectly. Either way, the claim will be denied.

Potential Solution
One solution may be to implement an Insurance Eligibility Verification feature using your Medical Billing Software. This feature can verify accurate carrier policy information before seeing your patient. With electronic insurance eligibility verification, you can feel secure knowing that the information is accurate. Inquiries can be submitted through the medical billing software system provider to the claims clearinghouse. In a matter of seconds you will receive a response.

The benefits of insurance eligibility verification are many:

	Minimize Claim Denials
	Increase Collections and Cash Flow
	Reduce Resubmitted Claims
	Accurately Set Patients Coverage Expectations
	Provides Accurate Determination of Co-Pay and Deductibles.

Eligibility responses provide pertinent insurance policy and coverage data, including:

	Patient demographics
	Name and address of patient's primary care provider so you may contact him/her.
	Policy number
	Policy detail - Coverage dates and status, to tell the provider’s staff whether a patient has insurance coverage on the date(s) healthcare is provided.
	Details on patient's medical group affiliation - to help you to submit claims to the appropriate party when payment responsibility is shifted away from the health plan.
	Details on patient's medical group affiliation - to help you to submit claims to the appropriate party when payment responsibility is shifted away from the health plan.
	Patient co-pay responsibility detail - to give you the correct co-payment required while the patients are still in the office.

Benefit information can include inpatient and outpatient benefits, pharmacy benefits, deductible accumulation, co-payment accumulation, stop-loss information, waivers, and restrictions.