Understanding Insurance Verifications and Authorizations

A statistical review strongly points to the fact that insurance verification and authorization is one of the critical components in avoiding patient ineligibility based rejections. Health insurance verification is all about verifying the patient’s insurance eligibility and all relevant details including the co-payments, deductibles, co-insurance, patient policy status, effective date, type of plan, and claims mailing address using online electronic verification system or by contacting the payer directly. Once the insurance benefit verification process is complete, insurance authorizations for admission is requested from the payer. This reduces insurance based coverage errors and minimizes rejections and denials. Insurance eligibility verification is a time-consuming and tedious task for most healthcare providers, considering the amount of responsibilities they handle. But they must understand the importance of medical billing and collections as well as its individual components such as verification, authorization and coding in making the billing process successful. Comprehensive Health Insurance Verification and Authorization Insurance verification and authorization services include: • Receiving patient schedules from the hospital or clinic via FTP, Fax or E-mailrn• Verifying patient information with the insurance carrier (verification of payable benefits, co-pays, co-insurances, 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) • Verifying patients’ insurance coverage on all primary and secondary payersrn• Updating patient accountsrn• Communicating with patients and completing paperworkrn• Updating insurance system with new and updated benefitsrn• Obtaining pre-certification number from physician’s office if necessaryrn• Completing appropriate criteria sheets and authorization formsrn• Contacting the insurance agencies via telephone, facsimile or online program to obtain approval for the authorization request • Contacting the insurance agencies for appeals, missing information and more to ensure accurate billing The Right Service Provider for the Best Results Medical professionals should give primary importance to insurance verification services because this can greatly impact their practice’s bottom line. Rejections and inappropriate payment result in rework and resubmission of the claims. So, medical professionals should be careful in selecting the right medical billing companies that deliver quality and cost-effective health insurance verification services. Outsourcing brings with it a wide range of benefits including speeding up approval and authorization; minimizing delays considerably; minimizing the number of returned claims and much more. Before handing over the task of insurance verification and authorization to a reliable outsourcing firm, make sure that it offers continuous evaluation of each account regarding the amount of returns possible and the timing; provides regular QA checking with readily available reports and follow all HIPAA guidelines.