Eligibility

IN-NETWORK & OUT-OF NETWORK BENEFITS CHECKING

Improper eligibility checking is the number one cause for claim rejections. Therefore, Eligibility checking is the single most effective way of preventing insurance claim denials.

Our team of Eligibility & Benefits Verification work on this process with the insurance provider.

The service begins with retrieving a list of scheduled appointments from Provider's office via Email/ Fax / FTP and verifying insurance coverage for the patients, from all Primary and Secondary Payers by utilizing Payer websites, Automated voice responses and Phone calls to Payers to verify if the patient has active or inactive coverage. We also use a combination of monthly eligibility/capitation lists and contact patient for information when necessary.

We generate results to include information such as member ID, group ID, coverage start and end dates, co-pay updates, deductibles being met or any specific procedures such as vaccine administration are covered.

In other cases we obtain Pre-Authorization Number, Referrals from PCP, and inform clients if there is any issue with coverage or Authorization.

Once the verification is done the coverage details are put directly into the appointment scheduler for the office staff's notification. 

The verification team ensures that every new or continuing patient's verification is completed before his arrival the healthcare facility. This proactive approach helps in following the rules required by the payer, for the patient to understand his financial obligations and validating the payment to be received from the patient and/or payer.