Insurance Verification & Eligibility

Imagine for a minute that you have received a denial in the mail for an insurance claim and it states that services are not covered or this procedure requires prior authorization. You think for a moment...why didn't someone know about this ahead of time.

Industry research shows most insurance denials are due to the lack of verifying insurance benefit information prior to services being provided.. Often, a patient would be ineligible for benefits because his or her policy has been terminated or modified. Patients presenting insurance cards that are no longer in effect or were never in effect results into delayed/decreased/uncollectible payments.

Go-Tech can deligently address this vital issue.

Related Services (optional):

  • Obtain Pre- Authorization Number
  • Obtain referral from PCP
  • Enter/update Patient demographics
  • Remind patient of POS collection requirements
  • Inform client if there is an issue with coverage or Authorization
  • Medicaid Enrollment

Eligibility verification defines who can render what care and under what circumstances. As such, ensuring that patients are eligible for services before care is rendered reduces rework of claims and alerts providers and patients to their options.

Eligibility Verification Services has the potential to:

  • Improve Account Receivable Cycles (reduce Account Receivable Days)
  • Increased number of clean claims
  • Increase cash collections by reducing write-offs and denials

Insurance Eligibility & Benefits Verification Services Include:

  • Receive Schedules from the Hospital via EDI, email or fax
  • Verify coverage on all Primary and Secondary (if applicable) Payers by utilizing sites like WebMD, Payer Web Sites, Automated Voice Responses and phone calls to Payers.
  • Contact patient for information if necessary
  • Provide the client with the results which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information and much more.