Eligibility and Benefits Verification
Insurance Eligibility Verification is the procedure of verifying a patient’s insurance in terms of three different statuses such as coverage status, active or Inactive status, and eligibility status. Insurance eligibility verification is very important as it is directly linked to claim denials or payment delays of a healthcare practice, especially the account receivables (A/R).
We receive daily patient schedules from the healthcare providers’ offices/clinics through integrated EHR and Practice Management System.
Our team access the EHR and Practice Management System and verifies patient demographic information to make sure everything is accurate.
Our dedicated eligibility and benefits solutions team will verify the patient complete, accurate and active eligibility, coverage and benefits details with their primary and secondary payers along with the policy effective and termination dates and confirms the coordination of benefits among the payers and obtain PCP and Specialists copays, Co-insurance percentages, deductibles and other out-of-pocket expenses both in-network and out-of-network.
We perform this process in the first week of every month to find out if there is any change in patient’s health plan and/or IPA and update the details in respective patient accounts in EHR and Practice Management System.
Our Services
We serve all your needs under one roof
Eligibility and Benefits Verification
Eligibility verification is the process of verifying a patient;s insurance in terms of Validity (Active/Inactive), coverage of benefits
Referrals and Prior Authorization
Our team is knowledgeable in each and every aspect of health insurance, healthcare terminologies and medical/surgical procedures, our verification specialists work with payers as well as patients
Provider Enrollment and Credentialing
Insurance credentialing services help to enhance the entire process of revenue cycle management. An efficient and streamlined workflow will lead to lesser claim denials and an improved patient experience.
Clinical/Utilization Reviews
We prepare concise clinical reviews of the patients by viewing EMR and including the abnormal findings of the patient to be sent to the facility for approval from converting OBS and ER patients to Inpatient
Medical Records Abstraction
Medical Record Abstraction services deliver fast, accurate abstraction of clinical data components that document the provision of compliant care for HEDIS® reporting, and other quality measurement needs. This service creates a base medical record for a patient by going through all the patient’s old medical charts.
Remote scribing
“Spend More Quality Time With Patients, Not Entering Data” Electronicmedical records (EMRs) improve efficiency and make medical information easier to share with patients, providers, and payors. However, all of that data entry takes time away from patients and adds time to a provider’s busy schedule. Our highly trained, remote medical scribes can help.