Intent healthcare solutions
Eligibility & Benefits Verification and Prior Authorization Services
Confirm eligibility and benefits, improve patient experience, and speed-to-care while improving collections.
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.
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
Medical Billing Wholesalers’ eligibility and benefits verification and prior authorization services offer:
In-house verification can be costly. Our team members based in India pick up the work queues and process each request diligently.
Efficient prior authorization processing means that the patient can be scheduled for care reviews with the physicians timely, thereby improving patient satisfaction as well as physician utilization.
Reduction in eligibility verification and Prior authorization related denials ensures that there is a lesser number of claim denials and cash flow is accelerated.
Upfront determination of Patient responsibility for payments reduces patient debts and improves POS collections, besides improving Patient Satisfaction
We work with all the major commercial and government healthcare payers including Blue Cross Blue Shield (BCBS), Aetna, Humana, United Healthcare, and others. Our team works with multiple medical specialties, across various states, and different size practices.
As we take over the entire process at less than a third of the costs, you can now refocus your employees on growing your business.
Request Additional Information
To learn about our comprehensive Medical Coding and Audit Services, please fill the form below and one of our representatives will get in touch with you.