Medical Insurance Verification Services

Medical insurance is a vital aspect of the long chain of medical billing. With a large number of patients looking for medical insurance, it is of utmost importance to keep track of insurance claims. For this purpose, the healthcare industry is dependent on medical insurance verification companies to function smoothly without any interruption or delay in the verification process and claims transmission. The insurance verification process is carried out to prevent any fraud that may harm the finances of the healthcare provider and the payer. It is the responsibility of medical insurance verification companies to review every patient’s insurance eligibility for the medical insurance plan he/she has applied for.

The major reason to outsource medical insurance verification services is to ease the process for all the concerned parties. Following are the steps that are involved in the insurance verification process:

  • Patient Scheduling/Registration: This step involves gathering all the data related to the patient’s appointment/schedule via email, fax, phone texts, etc. The health care provider may opt for self-scheduling to make the process easier and more streamlined. Patient scheduling is essential to boost productivity by eliminating long waiting lists, offering good patient care, and managing the revenue.
  • Patient Enrolment/Patient’s Record: The healthcare provider needs to gather and store the patient's demographic data. However, demographic data should be selective. This data can be divided into two categories—patient identification and medical history. Patient identification may include name, date of birth, address, phone number, and email id. The medical history may consist of previous medical issues and diagnoses. Any other information like father's name, emergency contact, insurance company/provider, and family doctor, etc. may be categorized as additional information. Patient enrolment establishes the identity of the patient to prevent any false insurance claims.
  • Eligibility and Verification: This is one of the most critical steps in medical insurance verification services. The medical insurance company is required to contact the insurance payer to cross-check the insurance details provided by the patient. The purpose is to determine insurance eligibility status, active/inactive status, and coverage status. This step is performed with the utmost care to avoid any discrepancy that may affect the A/R follow up. After the eligibility determination, it is vital to verify the insurance coverage benefits.
  • Authorization: This step is necessary to establish trust between the healthcare provider and the insurance payer. Authorization refers to the insurance payer's agreement to pay the health care provider for the medical services offered by him/her. The insurance payer is required to sign off the insurance claim. Here, documentation is imperative to prevent huge bills in case of denials.
  • Contacting Patient/Updating Patient: It is essential to stay in contact with the patient to get any additional information and to update the patient regarding any change.
  • Updating Medical Billing System: It is important to update the medical billing system in order to get correct payment details for claims submission.
  • Claims Transmission: Medical insurance verification companies offer a complete number of services to help the patient, healthcare provider, and insurance company with the medical insurance claims. Claims information is one such service that allows you to file insurance claims electronically.

Insurance claim and reimbursement is a long process with various steps. Each step in the process is interconnected and therefore is susceptible to get affected even by a minor mistake. This is where insurance verification comes in. By availing insurance verification services, healthcare providers do not need to worry about insurance fraud or denials.