Eligibility and Benefits Verification

Home Eligibility and Benefits Verification

Eligibility and Benefits Verification

Acceptance of any patient for a service is dependents on his/her Insurance Eligibility and available Benefits the service. Insurances pay the medical claims depending on the patient coverage and covered benefits. Eligibility and benefit verification is crucial to ensuring accurate and timely receipt of information regarding insurance coverage, and determining the patient’s responsibility to pay for healthcare services. Accurate and timely determination of the patient’s eligibility provides healthcare providers a clear view on patient’s coverage, out-of-network benefits and accurate insurance information. Incorrect insurance information may result in delayed payment at best, or denial at worst.

Performing eligibility verification helps healthcare providers submit clean claims. It avoids claim resubmission, reduce demographic or eligibility related rejections and denials, increase upfront collections; leading to improved patient satisfaction.

Rx RCM Benefits Verification team verified:

  • We verify primary, secondary and tertiary coverage details, including member ID, group ID, coverage period, co-pay, deductible / co-insurance information, and benefit information
  • We use the best channel (call or web) to connect with the payer.
  • We contact with the patient if needed to check if the patient has some other coverage (Auto, Worker Comps, Liability Insurances etc.)
  • We verify the Out of Network benefits also.
  • We verified the coverage of a certain service, if the service is covered or not under the patient plan and if the precertification is required or not to perform the service.