Eligibility & Benefits Verification
What is Eligibility and Benefits Verification?
In order to receive payment for their valuable services, healthcare providers must diligently verify the eligibility and benefits of each patient prior to their appointment. Astonishingly, up to 75% of denied claims can be attributed to patients not meeting the criteria for the
services provided by the healthcare provider. Regrettably, this crucial step in the revenue cycle is often overlooked, resulting in significant losses for healthcare facilities.
Impact of Ineffective
Eligibility/benefits verification and prior authorization processes:
Poorly executed eligibility and benefits verification and/or prior authorization procedures can lead to a multitude of issues. These can include a surge in claim denials, late payments, added strain from redoing the work, setbacks in patient treatment, lowered patient contentment, and failure to receive payment for services rendered.
Our Services:
At Soho Tech Services, we have a team of skilled professionals who are dedicated to streamline your client’s accounts receivable cycle. Our services include verifying patient eligibility and obtaining the necessary prior authorization prior to their visit with the physician. With our expertise, we ensure a thorough verification process for all our clients. “The healthcare provider’s office, including hospitals and clinics, provides the patient schedule. I then enter the patient’s demographic information and confirm their benefit coverage with their primary and secondary payers.” Coverage – whether the patient has valid coverage on the date of service.
Benefit options – patient responsibility for copays, coinsurance, and deductibles. Where required, the team will initiate prior authorization requests and obtain approval for the treatment. Update the hospital’s revenue cycle system or the patient’s practice management system with the details obtained from the payers.
Receive Patient Schedule from Provider's Office
Entry of Patient's Demographic Information
Verify coverage of benefits with the patient's primary and secondary payers
Where required initiate prior authorization requests and obtain approval for the treatment
Update the hospital's revenue cycle system or the patient's practice mangement system
Benefits of the Eligibility & Benefits Verification and Prior Authorization Services
Improve speed to care delivery:
Efficient prior authorization processing means that the patient can be scheduled for care reviews with the physicians timely, thereby improving patient satisfaction as well as physician utilization.
Reduce Claim Denials:
Reduction in eligibility verification and Prior authorization related denials ensures that there is a lesser number of claim denials and cash flow is accelerated.
Reduce Bad Debt, Increase Cash Collection:
Upfront determination of patient responsibility for payments reduces patient debts and improves POS collections, besides improving Patient Satisfaction
Expertise:
We work with all the major commercial and government healthcare payers including Blue Cross Blue Shield (BCBS), Aetna, Humana, United Healthcare, and others. Our team works with multiple medical specialties, across various states, and different size practices.
We also provide charge entry services. For more details, please visit our page.