The verification of insurance eligibility represents a critical initial step in the medical billing process. Research indicates that a significant number of claims face denial or delay due to insufficient or inaccurate coverage information provided by patients during their visits, as well as outdated coverage details not being updated by office or hospital personnel. This deficiency in proper insurance eligibility verification has a direct effect on reimbursement outcomes.

Reasons to pursue insurance eligibility verification include the fact that insurance companies frequently implement changes and updates to their health plans. Consequently, it is essential for medical billing companies or healthcare providers to confirm whether a patient is covered under the revised plan to ensure optimal reimbursement. Verifying insurance coverage enhances the likelihood of claim acceptance upon first submission, while failure to verify can result in various complications, such as the need for rework, diminished patient satisfaction, and an increase in errors, in addition to causing delays and denials.

At HANA HealthCare Solutions, we recognize the significance of insurance eligibility verification. Our services aim to:

• Enhance revenue generation
• Significantly reduce delays and denials
• Improve collections by minimizing write-offs

The insurance eligibility verification process at HANA HealthCare includes the following steps:

• Receiving patient schedules through EDI, email, or fax, or by checking daily in the appointment scheduling software.
• Verifying patients’ insurance coverage with both primary and secondary payers by contacting them directly and utilizing their authorized online insurance portals. We also reach out to patients for any additional information if necessary.
• Updating the medical billing system with eligibility and verification details, including member ID, group ID, coverage period, co-pay, deductible, co-insurance information, and other code-level benefits, including maximum limits allowed.
• Promptly informing the client in the event of any issues regarding a patient's eligibility.

HANA HealthCare’s dedicated team for insurance eligibility verification provides comprehensive support.