ELIGIBILITY & BENEFIT VERIFICATION SERVICES
An accurate eligibility verification process serves two important purposes for healthcare professionals, physicians, and hospitals. The first one is to avoid claim resubmission, claim rejections and denials. The second one is to increase upfront collection through clean claims. With eBotics, you can leverage the expertise of our medical insurance experts to revive and revamp your insurance eligibility verification process. It is a commitment to our clients that our skills and technological expertise will bring down your practice cost with quality deliverables.
When should eligibility be checked
Practices should proactively check eligibility. The most effective time is before the patient is seen by the physician, ideally 48 hours before the visit. In the alternative, this process can take place anytime up until, or at, check-in. Front-office staff should always ask patients if their insurance has changed since their last visit.
Benefits of eligibility & verification Services from eBotics
- Optimized cash flow.
- Reduced patient-related denials.
- Accurate verification of primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible, and co-insurance and benefits information & other code level benefits information including max limits allowed.
- Avoided rejection of claims by payers due to inaccurate or incomplete information.
- Identification of the patient’s responsibility upfront.
- Improved patient satisfaction.
- Prompt identification and resolution of missing or invalid data.
- In case of issues regarding a patient's eligibility, we inform the client immediately.
Insurance Eligibility & Benefits Verification process at eBotics
- We receive the patient schedule on email or on our secured HIPAA Compliant Sharefile or we pull the patient’s schedule from the EMR system.
- We call the payers directly/IVR or verify the eligibility & benefits through authorized online insurance portals and obtain the patient’s eligibility information like
- Member ID number & Group ID number
- Coverage effective/Termination dates
- Primary & Secondary coverage details
- Co-pay information
- If policy termed, other insurance coverage details and a detailed list of benefits depending on the patient’s plan.
- The eligibility & benefits information is directly uploaded in the respective patient account in the billing system. A copy of the report will be e-mailed to the client before the patient visit the doctor office.
- Our insurance verification team follow a standard questionnaire while verifying the patient’s eligibility & benefits. This questionnaire has been built in a way to zero out any rejections from the payers and ensure all the claims sent out reaches the payer as a Clean Claim resulting in maximizing the cash flow of the practice.
