healthcare

Insurance eligibility verification is a crucial step in the initial stages of the revenue cycle management and medical billing. This would tell us how much the insurance will be able to cover for the costs of the services provided to the patient. Thus, we can inform the patients upfront, for the charges that they have to bear, if any. This would speed up the money inflow avoiding denials.

Insurance verification is a process which includes validating and verifying the coverage, benefits and co-payment details of the patient and obtaining pre-authorization. It is important to complete this eligibility verification process before the treatment and medical services are provided to the patient. This enables faster payments and improves patient satisfaction. Failure in this step could end up in a huge unpaid claim from the insurance company and also burdens the patient with unforeseen heavy bills to settle.

Another challenge in this step is that many times, the patient provides the medical insurance details which are outdated. It becomes difficult for the health care service providers to validate the details and confirm if the patient is really eligible for the benefits or not.