Healthcare Insurance Eligibility Verification

Insurance Eligibility Verification is more critical today than ever with the advent of the Affordable Care ACT. In today’s insurance eligibility verification reality an ACA patient can have insurance one month and not pay their premiums in month 2 and 3. Qualified health plans are required to pay all claims for services rendered in the first month of the grace period (eligibility). Carriers will spend claims in the second or third months, at which point the patient must pay the provider for service already rendered or pay their insurance premium. If the patient cannot afford the payment for their premium, then any physician claims pending during this second and third month will go unpaid causing an increase in bad debt collections.

The process of obtaining the insurance eligibility verification of a patient is necessary to insure that the patient has coverage, services that are being provided are covered, denials and appeals can be minimized and payments are expedited at the appropriate rates. Denied claims due to no active coverage, out of network, unauthorized patient procedures or visits can be a major loss in revenue and should not be taken lightly.