Prior Authorization, Eligibility and  Benefits Verification Services

 Eligibility & Benefits Verification and Prior Authorization Services

What is Eligibility and Benefits Verification?

To receive payments for the services rendered, healthcare providers need to verify each patient’s eligibility and benefits before the patient’s visit. Some estimates indicate that as many as 75% of the claims getting denied are on account of the patient not being eligible for the services rendered by the healthcare provider. Unfortunately, it is one of the most neglected processes in the revenue cycle chain.

IMPACT OF INEFFECTIVE ELIGIBILITY/BENEFITS VERIFICATION AND PRIOR AUTHORIZATION PROCESSES

Ineffective eligibility and benefits verification and/or prior authorization processes can result in increased claim denials, delayed payments, additional effort on rework, delays in patient access to care, decreased patient satisfaction, and non-payment of claims.

Our Services

Medical Billing Wholesalers brings you a team  of experts to help you accelerate your client’s accounts receivable cycle. We confirm the patient’s eligibility and obtain necessary prior authorization before the patient visits the physician’s office.

Our team members will do the following as a part of the verification processes:

• Receive patient schedule from the healthcare provider’s office – hospital and/or clinic
• Perform entry of patient demographic information
• Verify coverage of benefits with the patient’s primary and secondary payers:
• Coverage – whether the patient has valid coverage on the date of service
• Benefit options – patient responsibility for copays, coinsurance, and deductibles
• Where required, the team will initiate prior authorization requests and obtain approval for the treatment
• Update the hospital’s revenue cycle system or the patient’s practice management system with the details obtained from the payers

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