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Insurance Verification Process – The Complete Guide

30Oct
Read Time: 3 minutes

Insurance Verification Process

Patient’s insurance eligibility verification is the process used by healthcare providers to verify the patient’s insurance coverage. This includes deductibles, policy status, plan exclusions, and any other items that affect cost and coverage. This always occurs before any treatments to understand how the patient will be paying.

The health insurance verification process is important for both providers and patients and is not always the easiest process to navigate. A recent report found that healthcare providers spent an average of 30 percent of their annual income in the insurance claim process.

The Critical Factors of Claim Rejection

Why is my claim getting rejected?

The primary factors of claim denial are incomplete insurance verification, missing patient data, claim billing errors, expired policies, coverage effective, termination dates, and duplicate data. These always result in claim denials, non-payments, claim rework, delayed payments, and could result in additional costs to the provider and the patient. Resulting in decreased revenue, patient dissatisfaction, and in these days of YELP and Google reviews, can even tarnish the reputation of the provider.

What should healthcare providers do?

The Optimal Way Out

Healthcare providers can eliminate setbacks by collaborating with the right outsourcing partner to assist and support the claim process and ensure a smooth revenue cycle. The right partner would:

  • Create streamlined and transparent processes
  • Provide expert guidance
  • Ensure steady cash flow
  • Minimize staff workloads
  • Be cost-effective
  • Understand HIPAA security and CMS regulations and guidelines

To see a comprehensive picture of insurance verification benefits, check out here. This briefly explains creating transparency and streamlined processes through outsourcing.

Complete Cycle of Insurance Eligibility Verification Process:

Patient Enrollment

It all starts with healthcare specialists providing patient information to their outsourcing partner. There, experts scrutinize the patient’s data and use it to begin the process of insurance eligibility verification.

Insurance Eligibility Verification

The most significant reason for claim denial is incomplete or missing data. An outsourcing partner should always ensure they have the most complete and up-to-date information. This happens by reaching out to the patient’s insurance provider. Some of the reasons a patient’s coverage may have changed are marriage, childbirth, or divorce.

Outsourcing insurance specialists will connect with primary and secondary payers to get a detailed view of the patient’s coverage. They will cross-check insurance coverage details to ensure the maximum claim will be met.

A providers outsourcing partner will send all of the up-to-date coverage information to them so they can notify the patient of their insurance eligibility status and any additional payment needs. Providers will also be given pre-authorization from insurance providers before any treatments.

Patient Follow up

Timely appointments and treatments are a must for claims’ eligibility.

By deploying automation tools, patient follow-up is simple. Using automation solutions and services, patients can receive notifications, emails, texts, or phone calls regarding upcoming appointments and treatments. In the case of appointment cancellation, patients will receive an instant notification and rescheduling options. All of this serves to enhance the patient experience and create satisfaction with their healthcare provider.

Updating the Billing System

A provider’s outsourcing partner will ensure the insurance verification process has been entered correctly in the provider’s billing system. A partner well-versed in the entire revenue and treatment cycle can ensure that all of the patient’s data are recorded properly from the initial appointment to final discharge.

Concluding Thoughts:

With a streamlined insurance verification process, a provider not only ensures steady cash flow, but they also see higher degrees of patient and employee satisfaction. It’s often advantageous for providers to seek help from outsourcing partners who specialize in the insurance verification process.

Are you looking for an outsourcing partner?

Connect with iTech. With a proven track record and skilled experts, the iTech insurance verification team is among the best. iTech offers services that are specific to each client’s needs. iTech maintains a strong HIPAA practice, is SOCII certified, and complies with all CMS guidelines and regulations. Call or email to find out more.


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    IDS Commander iTech2021