Insurance Verification & Eligibility


Verifying a patient's insurance eligibility is one of the most important functions in medical billing. The financial success of a practice is dependent on this important step.

Automating medical insurance verification is the best way to keep your patient collections in check. Most insurance payers offer online eligibility verification that provides up-to-date information about coverage, deductibles, and co-payments. Read this article to find out how you can automate this process to save time and money for your practice.

Checking insurance eligibility is an everyday function in the medical practice. Doing it manually is a tedious process of visiting various websites and/or making multiple phone calls. Visiting an insurance website requires logging in with user name and password, then entering patient name, date of birth, policy number to return the verification information. And because of the amount of time needed to do this, it usually happens only once, when the patient comes into the office for the first time.

But, what happens if the insurance coverage changes or terminates? It's a fact that the longer the time between the patient visit and when the statement is sent, the less likely the patient balance will be paid. Timely insurance eligibility verification combined with a well trained receptionist helps the practice collect their fees at the best time which is the time of service. 

One problem we see often, is a change in policy number. Either the first three digits of the policy number change or the entire policy number or group number changes. This causes claim rejections, phone calls to patients, and rebilling of claims. It's just easier to know these problems upfront and address them when the patient comes in.

Train your receptionist to ask the patient for their insurance card at each and every visit and compare the information to what you have on file. The insurance card should always be scanned into the system. It's a little more work, but it's worth it! 

The following are methods we and our clients use to obtain insurance verification information:

  • Insurance verification that is integrated within the patient scheduler - This is, by far, the most efficient method of insurance verification. The clearinghouse is seamlessly integrated with the practice management software. This saves time because it avoids switching screens and entering patient data twice. When integrated in this way, you can easily verify insurance benefits with a click of a button for any patient on your schedule before they are seen in the office. This is our preferred method. We use TotalMD practice management software integrated with Practice Insight EDI for many of our billing service clients.
  • Many clearinghouses offer insurance verification services directly from their websites. You log in using one user name and password and check benefits for all your insurance carriers. Office Ally offers this service at a very low monthly price.
  • Sometimes you just have to get on the phone and call the insurance company to confirm eligibility