Eligibility for Health Insurance

Verification of insurance eligibility and submitting a valid application

A clear understanding of the patient’s insurance coverage allows clinicians to provide the best treatment to the patient while minimizing the financial burden the patient faces. Insurance information should always be confirmed prior to clinical visits. By verifying insurance eligibility, we find out how much our patient and their insurer have to pay for healthcare services. It is vital that we receive coverage information on time and in an accurate manner

Failure to verify insurance eligibility can lead to:

  • A delay in reimbursement
  • Denial or rejection of claims
  • Longer wait times for patients

On the other hand, digitalization has the potential to deliver considerable benefits to the healthcare industry, such as more efficient, tailored, and cost-effective treatment, but it also poses obstacles. The reporting requirements of EHRs have been identified as a source of frustration for practitioners, robbing them of time and attention on patients. There are so many responsibilities that they are a leading cause of medical burnout.

Verifying insurance eligibility requires:

  • Precisely entering the patient’s personal information as well as his or her insurance coverage
  • Obtaining pre-authorizations by contacting the insurance company and verifying the policy
  • If necessary, changing the billing system and following up with patients

What are the purposes of verifying insurance eligibility?

  • Provide patients with a positive experience
  • Ensure that medical records are up-to-date for documentation purposes
  • Determine the appropriate treatment service according to the insurance plan
  • Determine the patient’s responsibility before the visit
  • Maximize cash flow and increase reimbursements with improved revenue cycle management
  • Minimize claim rejections and optimize claim submission

According to research, tens of millions of claims are denied each year due to expired eligibility or the medical service not being covered by a certain insurance plan. By verifying the patient’s eligibility, the billing staff can assess the insurance coverage for clean claims and avoid resubmissions or rejections.

What Makes Platinum Scribes Different?

Workflow Efficiency

Verifying insurance eligibility is done well before a clinic visit by using patient scheduling systems, insurance web portals, and telephonic discussions

Strict Confidentiality Observed

The confidentiality of the patient-provider relationship is respected and maintained. A patient’s information is never given to a third party without the patient’s written consent

We have the lowest rejection/denial rate

Well-trained experts gather every useful information by paying attention to the details, ensuring an extraordinarily low rate of insurance denials

Verifying eligibility automatically

Using advanced RPA tools, we are able to assess automated eligibility verification, which streamlines processes

More efficient Accounts receivable cycle

Patient flow is expedited, and account receivables are optimized, thanks to Platinum Scribes’s rigorous eligibility verification process

In compliance with the HIPAA regulations

Our main focus is HIPAA compliance. Personal electronic devices are prohibited inside the restricted access working area. All coordinators receive HIPAA training using our Learning Management System

Identify trusted contacts

In order to obtain pre-authorization for patients, Platinum Scribes’s professional staff works closely with patients and insurance providers via the best channels

Keeping detailed records

Primary and secondary coverage records include the member ID, group ID, coverage period, co-pay, deductible, and co-insurance information