The Intake

Insights for those starting, managing, and growing independent healthcare practices

5 tips to achieve 100% patient insurance eligibility verification

These strategies will help you improve your process for verifying medical insurance eligibility and achieve 100% eligibility verification.

Medical practice staff look at computer working on verifying medical insurance eligibility

At a Glance

  • Verifying patient insurance eligibility multiple times before appointments is crucial to prevent claim rejections.
  • Recording complete and accurate patient insurance information, using checklists and practice management software, is essential to achieve close to 100% eligibility verification and faster payments.
  • Leveraging automated eligibility verification services can reduce administrative workload for staff and minimize human errors that lead to claim denials.

Errors in eligibility verification are the main cause of rejection from payers and a major roadblock to increasing practice revenue. The good news? These rejections are also the most preventable.

Creating a strong process for verifying medical insurance eligibility and taking the time to check eligibility multiple times throughout the patient journey can lead to fewer rejections and faster payments. The following tips will help you improve your verification process and achieve 100% eligibility verification.

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1. Get ahead of insurance claims process in pre-intake when verifying medical insurance eligibility

Pre-intake is the perfect opportunity to tighten up the medical billing insurance claims process. It’s best practice to check eligibility 1-3 days before an appointment, so use the appointment-setting communication to ask for critical information ahead of time.

The following checklist will ensure you have all the information you need to complete eligibility verification:

  • Patient name, date of birth, address, and phone number
  • Insurance name, phone number, and claims address
  • Insurance information, including policy and group number
  • Secondary policy information, if applicable
  • Name of insured and dependent details
  • Relationship of the insured to the patient
  • Effective date of the insurance policy
  • End date for the insurance policy
  • Whether the coverage is currently active
  • Whether the procedure/service to be rendered is covered
  • Whether your practice participates in the plan
  • Limitations of the policy, including exclusions or documentation requirements
  • Whether prior authorization or referrals are required for payment
  • The amount of the patient's responsibilities like copay and deductible

If a patient is not the primary subscriber, you should also collect the primary subscriber’s name and date of birth. 

If a patient has no insurance, explain your financial policy and highlight the aspects that relate to self-pay responsibilities. In the event they ask about discounts and financial hardship policies, offer to send them a copy of the financial policy and financial hardship application in advance.

Remind every patient, new or established, to bring their ID and insurance card to every visit. ”

When you collect patient and insurance details early on, you can contact insurance providers to verify information prior to a patient’s first visit. This gives you time to resolve any issues that might arise and get clarification at the time of the appointment. 

Quick tip: Remind every patient, new or established, to bring their ID and insurance card to every visit.

2. Confirm insurance information before every single appointment

The verification process must always start with collecting, checking, and verifying patient information. This needs to happen whether a patient is new or established. Every time a patient arrives for their appointment, you should:

  1. Ask for their insurance card: If a patient is new, check their information against the details you collected during pre-intake. If there were issues with the medical eligibility check, get clarification from the patient.

Collect an insurance card for existing patients to check for policy or demographics updates, which may change in between visits. Nearly one-third of patients change employers each year, triggering a switch in insurance policies. 

  1. Make a copy of the insurance card: Having a fresh copy on file serves as a backup and ensures you have the correct information on file. Plus, you can check a patient’s information against your files when they return. 

While it may seem redundant to verify eligibility multiple times prior to a visit, it’s more time-consuming to obtain updated policy information after a claim has been rejected or denied. By pushing your practice to strive for 100% eligibility verification prior to the visit, you can achieve major improvements in your overall collections.

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3. Revisit the insurance verification checklist

Now that you have the patient’s insurance information, all relevant details from the insurance card need to be captured accurately. Any missing or incorrect information, even typos, could result in a rejection.

Make sure everything’s correct and accounted for with the insurance verification checklist from pre-intake.

Quick tip: Consider going digital. Practice management systems can integrate billing, offer real-time eligibility checks, and automate data transfers. This saves your team time and greatly reduces errors.

4. Contact the insurance provider

When you’ve collected and entered a patient’s insurance details, it’s best practice to contact their insurance provider to verify the information. If anything’s incorrect, you can make necessary updates before submitting any claims. Remember, the best time to contact a patient’s provider is before their appointment.

The best time to contact a patient’s insurance provider is before their appointment. ”

Phone verification takes a minimum of 20 minutes, depending on the provider and the type of insurance. The best way to verify insurance information is with an automatic verification service like Tebra’s. Easily submit insurance eligibility inquiries to hundreds of government and commercial insurance companies and get the details you need in a matter of seconds.

Automatic verification significantly reduces your billing staff’s administrative burden and helps you get paid faster.

5. Record complete and accurate information in the patient’s file

Once you’ve verified a patient’s insurance with their provider, transfer all the patient and provider details to the patient’s file or into your EHR. As always, accuracy is of critical importance. 

If possible, automate as much of this process as you can. Technology like robotic process automation (RPA) excels at error-prone tasks that don’t require human decision-making, like eligibility verification. The fewer errors you make, the closer you can get to 100% eligibility verification.

A strong process for patient intake and verifying medical insurance eligibility is mandatory for increasing revenue. Re-verifying eligibility at multiple points throughout the patient journey, as well as ensuring accuracy at every step, is key.

Digital solutions like Tebra’s insurance eligibility management can considerably improve your eligibility verification process. Automation takes the burden off your administrative staff and reduces human error, getting you closer to 100% eligibility verification and increasing practice success.   

Ready to reduce denial rates and increase revenue? Learn more about Tebra’s insurance eligibility management solution

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Kate Webb

Kate Webb has been writing in a professional capacity since 2010. She has extensive experience in healthcare, social issues, and community engagement projects with the goal of helping readers understand complex topics and make intimidating concepts more approachable. Kate holds a BA in political science from the University of British Columbia. She’s a proud member of the Lumeo RHIS team and the Southeastern Ontario Medical Association (SEAMO), helping transform the way patients and providers access health information.

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