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Handy Tips for Precise Medical Insurance Verification

For approving and billing of a medical claim, it’s important for care providers to verify the patient’s coverage plan. With the involvement of multiple factors including coverage providers, their network affiliations, coverage types, and many more, the verification process gets resource-hungry, error-prone, and time-consuming. But as the medical insurance verification determines whether care providers would get paid or not (and even payment delays), the importance of executing it flawlessly and efficiently can’t be overstated.

To the utter delight of care providers, there exist ways by following which they can correctly and quickly verify the claim submission requirements.

Maintaining an extensive checklist

As the verification process comprises a bunch of details, relying on a checklist is a prudent move. The list should include information such as the basic info of the patient, effective and end dates of the policy, insurance ID and group number, etc. Also, it’s equally important to maintain caution while transcribing the information into the patient record as it forms the foundation of the claim. If required, there should be follow-ups with the patient and the exchange of relevant information. The use of patient portals, emails, and other forms of online communication come handy at this stage.

Verifying the authorization

For the primary care provider, it’s not enough to just check if the patient’s insurance coverage is active or not. Verifying whether their services require any referral or pre-authorization saves them from claim denials. To increase the chances of getting paid, they must submit the claims at the earliest as authorization is usually open for not over 30 days. For referral cases, the patient must acquire referrals from the primary care providers before they visit the office. It’s a good practice to maintain all referred documented in the patient’s record.

The insurance card and website give vital information

The best way to get the details of the plan is usually through the insurance identification card along with the phone numbers for all members and concerned providers. This lets the verifiers get the plan details and then check them against the claims made. Besides, checking out the official website of the insurance carrier can reveal critical information. Another option is to call the helpdesk of the carrier to corroborate the claim details. The verification of the patient’s eligibility can also be carried out with clearinghouses and practice management systems.

Use of automation

The use of smart technology like automation can do wonders for the insurance verification process. Technologies such as Artificial Intelligence (AI) and Robotic Process Automation (RPA) can not only give accurate results but also reduce the time and costs involved in the process. With such possibilities, seemingly difficult tasks like processing of batch verification in real-time, determining patient obligation, and facilitating payments get exceedingly easy. The room for error is very low and concerns regarding rejections of claims owing to patient eligibility error, billing the wrong payer, etc. are effectively eliminated.

Being proactive in the medical insurance eligibility verification process is the key to the desired outcomes as it mitigates financial issues and compliance risks. The above-listed tips and methodologies, if followed thoroughly, would certainly be an effective tool for the care providers in the onerous task.


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