Real-Time Healthcare Insurance Eligibility - An Overview

Unfortunately there are chances of getting into a fatal accident at any given time, leaving people incapable of performing their work responsibilities. In such cases, having real-time active Health Insurance is imperative to cover the victim’s financial expenses. Health insurance can off-set the costs for treatment such as ambulance services, ED, imaging needs, urgent care, etc. 

Healthcare Insurance Eligibility

At the time of care, providers need to verify whether the patient has coverage. This is done with the help of an exchange of electronic data between the provider and payer. Important information the providers are looking to collect include:  

  • The spelling of the patient's name

  • Their address, both current and permanent

  • Their insurance carrier number and social security number

  • The policy status of the patient and its effective date

  • Their group number, payable benefits, and plan exclusions. 

Finding accurate patient demographics and real-time health insurance eligibility is the first and most important step of claim preparation. 

How to Verify Patients’ Real-Time Health Insurance Eligibility

  1. Who is the patient?

    Prior to verifying a patient’s coverage, you must first verify the patient identity. This includes the patient’s name, date of birth (DOB), current address and social security number (SSN). Inaccurate data caused from spelling errors or outdated information can lead to reprocessing claims after recollecting patient information.

  2. Who is the payer?

    After correctly verifying the patient’s identity, providers must match the patient to their insurance plan. Verification via real-time health insurance eligibility ensures whether a patient has medical insurance coverage.  

Automated solutions for verifying patient demographics and real-time healthcare insurance eligibility

medical-business-doctor

Automated solutions such as intelligent verification provide real-time healthcare insurance eligibility information so the medical staff can capture all required patient information and send and receive a verification from insurance portals. This real-time healthcare insurance eligibility verification ensures the patient is covered on the Date of Service.   

Implementing automated, real-time intelligent verification assures the patient of the proper coverage of health expenses and provides your staff with:  

  • Demographics of the patient

  • Medical coverage and benefits options such co-insurance and secondary plans

  • The address Payer has in their system 

Major benefits of Real-Time Eligibility Verification: 

Solution

The solution to maximizing reimbursements is finding the most accurate patient demographics and insurance eligibility verification from the first step of claim preparation. This comes before everything else. If the patient data is inaccurate, it will affect the entire claims process, leading to rejections, denials, or write-offs.

Previous
Previous

How No Surprises Act Affects Healthcare Insurance Eligibility

Next
Next

How Automating Patient Demographic Verification Can Improve the Billing and Reimbursement Process