VERIFICATION & PRIOR
AUTHORIZATION
NEED FOR ELIGIBILITY VERIFICATION & PRIOR AUTHORIZATION SERVICE
Eligibility and insurance verification are critical to receiving accurate and timely information about insurance coverage. As a healthcare service provider you may be wasting money if necessary checks and balances are not in place.
Ineffective eligibility and benefits verification and or prior authorization processes can lead to increased claim denials, delayed payments, greater effort on rework, poor patient satisfaction, and others.
NEED FOR ELIGIBILITY VERIFICATION & PRIOR AUTHORIZATION SERVICE
Eligibility and insurance verification are critical to receiving accurate and timely information about insurance coverage. As a healthcare service provider you may be wasting money if necessary checks and balances are not in place.
Ineffective eligibility and benefits verification and or prior authorization processes can lead to increased claim denials, delayed payments, greater effort on rework, poor patient satisfaction, and others.
WHAT’S INCLUDED
Care MSO provides a team of experts to assist you in shortening your client’s accounts receivable cycle. Before the patient attends the physician’s office, we establish their eligibility and receive any necessary prior authorization.
- Enter the patient’s demographic details.
- Verify benefit coverage with the patient’s primary and secondary payers:
Protection – whether the patient has valid insurance on the day of service Optional
benefits – co-pays, coinsurance, and deductibles are the patient’s obligation.
- Obtain a patient schedule from the healthcare provider’s office – hospital, or clinic.
- Where necessary, the team will begin prior authorization inquiries and acquire therapeutic permission.
- With the information collected from the payers, update the hospital’s revenue cycle or the patient’s practice management system.
ELIGIBILITY VERIFICATION & PRIOR AUTHORIZATION PROCESS
Get the patient’s schedule from the provider’s office.
01
Patient Demographic Information Entry
02
Verify coverage of benefits with the patient’s primary and secondary payers
03
Initiate prior authorization requests as needed and secure treatment approval.
04
Update the revenue cycle system at the hospital or the patient management system.
05
THE PERKS
IMPROVE THE EFFICIENCY OF CARE DELIVERY
Prior authorization processing that is efficient allows patients to be scheduled for care reviews with physicians more quickly, boosting patient satisfaction and provider utilization.
DECREASE THE NUMBER OF CLAIMS DENIED
Reduced eligibility verification and prior authorization-related denials result in fewer claim denials and faster cash flow.
REDUCE BAD DEBT AND BOOST CASH FLOW
Patient accountability for payments is determined upfront, decreasing patient debts and increasing POS collections while also enhancing patient satisfaction.
CONCENTRATE ON EXPANDING YOUR COMPANY
You can now refocus your workers on developing your business. At the same time, we take over the entire procedure for less than a third of the expense.
