Eligibility

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 eligibility process can reduce the number of denials and increase your revenue. When scheduling a visit, the front office staff should obtain and verify the patient’s demographics. During the call, the patient will need to provide the information listed below. This information will aid in the verification process.

• Payer Name

• Claims Address

• Payer Telephone Number

• Policy Number

• Group Number

• Policy Holder name and relationship to patient

• Policy effective date

Upon arrival at the healthcare facility, the patient will need to supply the front office staff with their insurance card. The healthcare facility will need to upload a front and back copy of the insurance card into the electronic health record system. A copy of the card is needed to ensure accuracy of all information received from the patient prior to the visit. It is also useful for the billing staff to have in case they need to use it for future reference in situations where a staff member may have miskeyed any data.

Insurance eligibility can change daily so it is customary to check eligibility 2 weeks before the visit as well as reverify within 2 business days of the scheduled visit. When verifying eligibility, it is necessary to check for additional payers as well as the order of each payer.

Contact C & T Healthcare Revenue Solutions LLC for your eligibility needs.