top of page
  • Writer's pictureC & T Healthcare Revenue Solutions


Updated: Nov 25, 2020

Benefit Verification is a critical component of all healthcare related visits. This step ensures all providers and healthcare facilities receive payment/reimbursement for all services rendered. When conducted properly, the healthcare provider will be able to determine the patient’s out of pocket responsibility. Eligibility is conducted to ensure the patient has active coverage with the payer. Benefit Verification is to ensure the services rendered are a covered benefit under the payer for the member/patient.

Eligibility and Benefits should be verified before each visit transpires. Doing so will indicate a change in coverage to include but not limited to out of pocket cost and pre-authorizations.

Here are some of the items that are you able to obtain from the carrier when you are conducting benefit verification:

  • Co-Payments

  • Co-Insurance

  • Deductibles

  • Payable Benefits

  • Effective date

  • Plan & coverage details

  • Plan exclusions

  • Specific coverage

  • Claims mailing address

  • Referrals & pre-authorizations

  • Lifetime maximum benefits

  • Patient policy status

Some patients will have more than 1 carrier. In cases such as these, you will verify if the coordination of benefits (COB) is on file with all payers. The benefit verification process will cover the coordination of benefits with secondary and tertiary payers.

Conducting proper eligibility and benefits before the visits ensures patients have an estimation of out of pocket cost for the services rendered and are willing and able to pay or make the proper payment arrangements.

Having proper policies in place is a key component of the financial success of a healthcare organization.

Contact us at (888) 208-4227 or to speak with one of our team members to find out how we can assist you with any component of your revenue cycle or day to day operation processes.

57 views0 comments

Recent Posts

See All


Credentialing is a necessity for providing medical care that requires insurance reimbursement. It is imperative that all medical providers and facilities complete the credentialing process when they m


Over 20% of claims are denied due to insurance coverage issues. This can amount to millions of dollars of lost revenue for any healthcare facility. Ensuring your staff is properly trained on the elig


bottom of page