How to verify patient insurance eligibility in 4 easy steps?

One of the most time-consuming yet critically needed requirements of running a hospital or a clinic is verifying/validating a patients’ insurance coverage eligibility. The staff of hospitals and practitioners engaged in the process of billing struggle through loads of work and intense deadlines. Dedicating their efforts to the tedious task of verifying the insurance coverage can be a daunting task. The result of this is a serious impact on the reimbursements due to rejected, denied or delayed claims on account of the submission of incomplete or wrong information about the patient’s coverage in the insurance claim forms.

verify patient insurance eligibility

verify patient insurance eligibility

The insurance payer can reject the claims several times and this can also make your patients dissatisfied with the service. The process of verifying this important piece of information is not only lengthy but also requires a thorough knowledge about the universally acceptable medical codes and their error-free application in the claims. Therefore it is imperative to take professional assistance for completing this process easily and swiftly.

The patients’ insurance coverage eligibility must be checked before the patient avails of any medical care service, gets hospitalized, indicates a change in his or her insurance coverage plan or has availed any new insurance plan or for the first time. Often the insurance payers also make changes to their plans. Keep a track of these changes and assesses what impact has it had on the patients’ coverage eligibility. Having the right information enables you to file complete and error-free claim forms, estimate the patients’ responsibility and share of payment and apply for maximum reimbursements.

The verification process comprises of the following steps:

  1. Gathering critical patient information: In this step, all the information regarding the patient, his basic demography, medical history, diagnoses, insurance plan, and more are gathered through reliable sources such as the hospitals, clinics, or from the patients themselves. You may contact the hospital staff, clinic staff over the phone to gauge all the information. It is a complicated task as mostly these people are not available to give out all the information due to lack of time or commitment to their respective work. The patient can also be contacted directly to take all this information.
  2. Verification of patient’s Coverage information: In the next step the information collected from the patient or the staff of the hospital is then verified with the carrier. This includes verifying information regarding insurance coverage, payable benefits, co-pays and co-insurance, details on the plan related to coverage, date of coverage, type of plan, exclusions, deductibles, and other key details about the insurance plan.
    Primary and secondary payer verification: This step includes verification of patients’ coverage on all the primary and secondary payers and determines which one is primary and secondary coverage based on coordination of benefit. Accordingly, the claim has to be routed to primary coverage first.
  3. Updating the information: the next step includes updating all the information collected into the patients’ respective accounts. This information must be kept handy at the time of claim submission to minimize rejections and denials.
  4. Touching base with the customers and completing final formalities: the last step includes interacting with the patient and completing the paperwork before the service is provided. If there are any discrepancies in the eligibility and coverage information collected by you and that presented by the patient, this is the time to clarify.

Following these simple steps will go a long way in increasing your revenues and reimbursements for the medical care services provided. A professional service provider, like eClaimStatus, helps you in easing out this process. They are well-versed in all the aspects of healthcare, medical billing and coding, insurance verification tactics, and more.


Leave your insurance eligibility verification to eClaimStatus. Get started with your 15-day free trial, call us at 310-294-9242 or write to us sales@eclaimstatus.com

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