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Everything You Need to Know About Insurance Verifications and Authorizations

Insurance verifications and authorizations are an integral part of medical billing services. Verifying insurance eligibility and getting authorization is very essential when it comes to providing covered services for your patients. Non-verification of insurance eligibility may lead to problems such as delayed payments, rework, increased errors and patient dissatisfaction. wmlink wire
Insurance verification and insurance authorization is the process of validating the patient’s insurance details and obtaining assurance by calling the insurance payer or through online verification. The process ensures verification of payable benefits, patient details, pre-authorization number, co-pays, co-insurance details, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, claims mailing address, referrals and pre-authorizations, life time maximum and more.
Health Insurance Verification Process
The process of insurance verification and authorization include the following steps:
• Ensuring benefits for all patients before submitting to payers for approval
• Getting patient schedules from the hospital or clinic via fax, e-mail or FTP.
• Checking patient information with the insurance carrier
• Verifying patients’ insurance coverage on all primary and secondary payers
• Updating patient accounts
• Communicating with patients and completing paperwork
• Updating insurance system with new and updated benefits
• Obtaining pre-certification number from the physician’s office if necessary
• Completing appropriate criteria sheets and authorization forms
• Contacting the insurance agencies to obtain approval for your authorization request, for appeals, missing information and other relevant things to ensure accurate billing.
Other optional services which are provided as a part of insurance eligibility verification process include: obtaining pre- authorization number, reminding patients of POS collection requirements, obtaining referral from PCP; informing clients if there is an issue with coverage or authorization and Medicaid enrollment.
Outsourcing insurance benefit verification process and obtaining insurance authorization provides a wide range of benefits for healthcare facilities. Listed here are some of the advantages of outsourcing insurance verification services.
• Fewer claim rejections
• Speed up approval and authorization
• Maximize reimbursement and minimize denials
• Simplified workflow
• Increased number of clean claims
• Faster billing cycles
• Improved staff productivity
• Reduced rework of claims
• Maximize office efficiencies and economies of scale
• Boost revenue
• Reduce capital costs
• Expand company focus
• Improved staff productivity
• Devote more time to core business objectives
• Save 30 to 40% of your operational costs
• Increased upfront collections