Insurance Eligibility Verification Services in Healthcare

As per the recent Healthcare Industry statistics, one in every four claims is usually denied, postponed or declined due to various issues in insurance verification services in Healthcare. In a medical billing and coding process, Insurance eligibility verification is counted as the primary and one of the major steps. Most of the times, the claims are delayed or denied due to incorrect or incomplete details submitted by the patients during their visits to the hospital or clinic or when the current coverage is not updated by the provider’s staff. This may result in delayed reimbursements and also directly impacts the cash flow of the practice.

Outsourcing Insurance Eligibility Verification process to a trusted and reliable service provider can work in a great way. Our experienced team of medical billing and coding experts gets regularly updated with all the changes in health policies and is well-equipped to avoid denials and delays of claims. At Bikham Healthcare, we have been delivering quick and efficient Insurance credentialing verification services to our prestigious clients, for more than a decade.

How many types of insurance eligibility verification are there?

Two main types of insurance eligibility verification are; (i) Basic and (ii) Advanced insurance eligibility verifications.

In the basic verification process,

  • First, the eligibility timeline is verified, including both the coverage and effective from and to dates. Then, general patient name, detail, address, contact information, insurance coverage information, claim filing limits, any pre-existing conditions, type of plans, the provider is in-network or out-of-network is identified and then entered into the relevant form for Insurance eligibility verification.
  • Besides the above verification process, the co-insurance, co-pay, dependent insurance, and other deductibles are also verified.
  • Such Insurance Verification Services in Healthcare process is recommended, in the first quarter of when the insurance policy is due for renewal and patients may or may not renew their insurance coverage.
  • Also, in a group health insurance, various benefits should be verified. Usually, various insurance benefits are provided in the list of order; primary, secondary and tertiary.

In the advanced verification process,

  • All the aforesaid steps of basic verification process are undertaken.
  • Additionally, certain other details such as the rate of renewal frequency, annual or a monthly, availability of health fund, maximum benefits of coverage that is already used or taken for the calendar year, co-pays for lab service, tests, pre-certification and authorization requirements, injections etc.
  • Also, any exclusions or limitations in policy, specialty service-related detail such as for cardiology, general surgery, and physical therapy, etc. DME-related information and the ‘annual maximum’ or ‘lifetime maximum’ benefits limits are verified.

What are the Services Offered by Bikham?

At Bikham, we have more than 13 years of expertise in offering the medical billing and coding services to several prestigious clients around the globe. As a trusted partner, we can better understand the need for an error-free Insurance eligibility verification of medical insurance claims.

We understand the importance of accurate verification of medical insurance claims for the precise medical services. Our key offerings for Insurance eligibility verification process include –

Checking of Documents

Once we get the documents from insurance providers or the healthcare organizations, first, we completely analyze all the documents and then verify it to the list of the essential documents. This process helps to organize the documents as needed by the insurance company.

Verifying Coverage of Patient’s Insurance

Insurance coverage of the patient is verified by the primary and secondary payers either by checking their official online insurance portals or by directly contacting them.

Follow-up with Patients

Any missing or incorrect information is immediately verified, whenever needed, by contacting the patient. This helps in cross verifying important details and keeping track of all the needful information before the final submission of data.

Final Submission

Final result to the client is provided including the information about patient’s Insurance Eligibility Verification, benefits covered along with other details, such as member ID, group ID, co-pay information, start and end dates of the insurance coverage, etc.

Why should you opt for Insurance Eligibility Verification Services?

Verifying the Insurance Eligibility Verification of patients is of extreme importance because it directly affects the cash-flow.

What is the Importance of outsourcing Insurance Verification Services in Healthcare?

Various key benefits are summarized below:

Enhances Cash Flow

An easy access to the updated insurance Eligibility Verification information allows better chances of getting the claims accepted quickly along with high success rates. This helps the healthcare organizations in maintaining constant cash flow by minimizing denials and write-offs and increasing overall patient satisfaction.

Efficient Workflow

A consistent and concise insurance credentialing services help to improve the overall efficiency of the process. By following such an efficient and streamlined workflow will come out as fewer denials and superior patient’s experience.

Enhances Self-Pay Revenue

Healthcare providers can get the added reimbursement opportunities by electronically matching self-pay patients with managed healthcare databases. This also helps in identifying patients who have unknown coverage to restructure them and submit their claims, frees self-pay patients from financial burdens.


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