It is the process of verifying if the patient’s insurance coverage plan is active for the following medical procedure. It is essential to primarily verify if the patient’s insurance plan covers the medical procedure so you can notify them about their expenses. Also, it helps healthcare providers and their medical billers to prepare and submit medical claims to the relevant prospects.
Pre-authorization/prior authorization is usually used for non-emergency medical procedures and diagnostic services. It is used to get prior approval from the insurance company about the medical necessity of medical tools, equipment and services delivered to the patient. If not justified properly, then usually healthcare insurance companies refuse to pay for such medical claims.
At CureCloud, we provide complete solutions for eligibility verification and prior authorization services. Also, we provide insurance verification services to ensure if the treatment is being delivered to inpatient or outpatient.
What Are Eligibility Denials?
When the healthcare staff doesn’t collect and verify insurance and benefits’ eligibility during preregistration or at registration then they can miss out on the chance to mention accurate and updated demographic information of the patient in medical claims. Therefore, eligibility verification solutions are essential to help you collect and update patients’ information. Otherwise, medical claims with outdated information usually get denied.
Such claim denials also happen if the patient’s coverage plan changes during their stay at your healthcare faculty or hospital. Usually, when patients stay for one month or more than that in your hospital or clinic because there are chances that during this time span their coverage or benefit plan could update.
Therefore, you always need a dedicated workforce to track your patient’s demographic information and keep it updated in your database. So your claims can get approved on the first attempt of submission.
At CureCloudMD, our eligibility verification specialists track and verify patients’ coverage eligibility from registration till claim submission. We use automated solutions to keep your record updated in EHR/EMR in order to prepare accurate claims.