Insurance Benefit Verification in short (BV) is a process of verifying the patient’s active medical insurance coverage. The patient access team at the time of patient registration along with their other responsibilities such as appointment and scheduling, patient registration, collection and preparation of the EHR of patient/ insurance demographic details (face sheet), medical record preparation, collection and posting the co-pay into the PMS and responsible to check the benefits under the patient’s insurance coverage.
Traditionally the staff from the service provider’s front office or the Centralized Billing Office (CBO) call the insurance company collected during the patient registration process to
- Check the policy effective/ termination date
- Deductibles or any other out of pocket expenses if applicable
- Find out if the plan benefits cover the services scheduled for the patient
- Patient responsibilities and plan coverage for the CPT’s based on the fee schedule
- Obtain authorizations required for the scheduled services by providing the necessary medical records
- Check the claims mailing address in-case of paper claims and the electronic payor ID in-case of Electronic Data Interchange (EDI)
- Filing limit of claims to avoid untimely filing denials
- Obtain the Co-ordination Of Benefit (COB) information if we do have any intimation of other insurance coverage obtained during the registration process
- Obtain Medical Group Information in-case of involvement of an HMO
All these tasks are time consuming and require human intervention one way or the other to function and gather the data thus capping up the efficiency that is directly proportional to the cost of human labours.
On the other end, Insurance Discovery software is a tool that’s created by a group of veterans in the healthcare industry combining Artificial Intelligence (AI) with Machine Language. The software consists of 15 algorithms that’s programmed to perform complex search functions by checking multiple permutations and combinations to retrieve the patient’s insurance demographics, coverage and benefit details within a click of a button. The Insurance Discovery tool has the ability to upgrade the algorithms based on the output retrieved from the insurance payers.
Below are few scenarios which are common when the patient visits the healthcare provider
- Patient/ Guarantor forgets to take their insurance card copy during their visit
- Patient/ Guarantor may not remember the
- Correct unique ID number provided by the insurance company
- The group number of the patient
- HMO details of where the claims are to be sent
- Coverage and benefits details
- Deductibles and other out of pocket expenses
- Other active healthcare coverage through the employer or spouse
- Patient may not be in a condition to provide the insurance demographic details
During these situations obtaining the complete insurance healthcare is still vital for billing purposes to avoid any future delays/ denials/ un-reimbursements or write off’s.
The Insurance Discovery tool retrieves all the active coverage for the patient by entering a few patient demographic details. The information retrieved can be used in updating the face sheet or cross verifying the information provided by the patient. In addition the tool has the capabilities to provide the COB (Co-ordination Of Benefits) information. The tool is created to support retrieval of accurate insurance data including from payor plans such as HMO’s and Medical Groups. The COB sequencing of the payors is provided to the CBO. The tool maximises the efficiency of the patient access team saving time and effort.
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