Eligibility Verification & Authorization

Eligibility Verification & Authorization

One of the most important parts of medical billing to receive payments for the services rendered is E&B verification. It’s always important that before the Patient’s appointment takes place we verify their eligibility with Insurance and also verify their benefits coverage for the services to be rendered.

The first part (Eligibility Verification) include verifying:

☑️ Active coverage with Insurance

☑️ Type of Plan

☑️ PCP requirement

☑️ Provider In-network/Out-network

☑️ What is the patient responsibility for the office visit (i.e. Deductible, Co-pay, Co-insurance)

Claim submission address & payer ID (if not already known)

The second part (Benefit Verification) includes:

☑️ Verifying coverage specific to the Services going to be performed

☑️ Checking if authorization &/or referral is required for the services or not

☑️ What’s going to be Pt responsibilities for the services

Our PROCESS FOR E&B VERIFICATION

For scheduled appointments:

1. Taking patient schedule from the provider’s office

2. Verify coverage of benefits with patient’s primary and secondary payers:

2a) General coverage

2b) Benefit verification

3. If authorization is required, then initiating auth requests and obtaining approval for the treatment.

4. Updating the EHR software of the office with all the details.

5. We prefer if we receive a schedule three days ahead so that within 24 hours we can provide you with details, and in case there’s any problem with the patient's Insurance front desk get enough time to call & inform the patient in advance so they can resolve the issues.

For the walk-in patients:

1. There could be walk-in patient flow in the practice as well.

2. In that case, as per the office shift time, Our staff would be available & once receive a verification request from the provider's office, would complete that on priority so the provider can see the patient.

Contact Us today to get the most cost effective solution available in the Market.