10 MISTAKES TO AVOID WITH PATIENT BENEFIT VERIFICATION & PRE-AUTHORIZATIONS / PRE-CERTIFICATIONS
Benefit Verification with Online Portals & EMRs is Inaccurate & Incomplete; a Single Mistake Could Cost You Thousands of Dollars in Claim Denials
Insurance Company Reps on the Phone have Access to 3 Times More Data Than Online Portals, Data that is Absolutely Necessary to Get Your Claims Paid
Online eligibility verification is a tempting shortcut, but ultimately counterproductive. Online portals and EMRs can only retrieve limited data from insurance companies. As a result, they provide inaccurate and incomplete information. The solution - have us call the insurance company, ask all the right questions and spend as much time as needed to get you accurate, detailed patient benefits, pre-certification and pre-authorization information for all your procedures before you start treatment. You stop worrying about claim denials and slash your front desk workload by 50%. We become an extension of your clinic. The result - Happy patients, happy staff and less claim denials.
Not having accurate (and comprehensive) benefits information and pre-authorizations is THE number one reason for claim denials. Let's face it - no one enjoys calling payers to verify benefits. It's far more tempting to click a few buttons in web portals to get patient benefit verification data. However, this data is often incomplete, and a single mistake can cost you tens of thousands of dollars in claim denials. There are no shortcuts, and the only way to get the most accurate and reliable information is to get the information the old-fashioned way by calling the payer, asking a specific set of questions, and getting a call reference number at the end of the call.
Denial reasons include benefit caps, policy/coverage is no longer active, authorization denied, and denial for non-covered services. This results in payment rejections, and even permanent loss of income due to delayed or improper submission.
Some clinics deal with this by having staff on the phone, for 30-45 minutes or more for each phone call, as they try to get answers from an insurance company.
Others rely on technology for eligibility information online, but the information from online portals is not accurate, and in most cases, incomplete.
The good news - We present you with a new way that is less expensive, and more efficient, by making the calls for you with a pay-as-you-go service.
You provide us with these data points about your patient through a secure, encrypted online portal:
Leave the rest to us.
No need to call the payers. We get on the phone and get you all the information, even if it takes us upwards on 45 minutes for each call (that's our problem, not yours).
Focus on patient treatment and patient satisfaction. Get paid.
We call the payer, and get you the following in a secure, encrypted manner, mostly within 2-6 hours.
Imagine a day in your clinic where every new patient had eligibility verification and pre-authorizations done and available to you, without a single member of your staff spending a minute on hold with an insurance company - all for a fraction of the cost of doing this in-house.
Eligibility Verification is a powerful and effective service to combat claim denials for reasons such as 'non-covered service' and denials due to lack of eligibility and pre-authorizations.
Our service includes a summary of communication with the payer and provides you with all relevant information - in many cases, before a patient walks into your clinic.
We have a large team of specially trained callers who pick up the phone and call the appropriate insurance company for every single patient and provide you with detailed information before you start treatment.
The number one problem with claim denials - inaccurate benefits information and pre-authorizations is solved. Watch your claims get paid and your reimbursements skyrocket
It costs less to invest in our specially trained team to handle eligibility calls than to have your internal staff waste endless hours on the phone.
Your staff should be spending time on other important tasks to improve patient experience and grow your practice, not sitting on hold with an insurance company.
You get current information about all patient benefits and can be assured that your claims won’t be denied due to eligibility or pre-authorization issues.
Whether it takes us 5 minutes or 60, we'll stay on the phone with the payer as long as needed to get you all the information to submit a clean claim and get paid. When you use our eligibility verification and pre-authorization service, you’ll save money, collect more from payers, and grow your practice.
If I choose the plan, it includes ____ verifications per month. If I exceed ____ verifications and request additional verifications in that month, I will be charged an additional (____ x $____ = $) , so my total cost for that month will be $____.
If you see new patients a week, the ____ plan makes sense because you'll do ____ verifications a week, plus additional verifications during re-evaluations / progress notes (highly recommended). You will also need pre-authorizations for many of your patients. You will need around ____ verifications each month.
With the starter plan, the cost is $12 per patient verification with a monthly minimum of 50 verifications / pre-authorizations. If this number is not reached, you will still pay the minimum charge for 50 verifications, which is $600 for that month.
With the growth plan, the cost is $10 per patient verification with a monthly minimum of 200 verifications / pre-authorizations. If this number is not reached, you will still pay the minimum charge for 200 verifications, which is $2000 for that month.
With the Enterprise plan, the cost is $8 per patient verification with a monthly minimum of 500 verifications / pre-authorizations. If this number is not reached, you will still pay the minimum charge for 500 verifications, which is $4000 for that month.
There is no carry forward of unused verifications with any plan.
Our pricing model is simple and transparent - no contracts and you can cancel anytime.
If you pay a staff member $15/hr, and they spend 45 minutes getting eligibility information, entering this information into your EMR and filling out authorization forms, you've now invested about $10 into the eligibility verification for that patient, and you may still end up with incomplete / inaccurate information, which ends up costing you much more.
We call the payer, and stay on hold for as long as it takes to get you the information you need.
We know exactly whom to call, and what to ask. You'll have the information the second we do. We become an extension of your facility.
Payers regularly make policy changes without notifying you, and most patients don’t know their current policy benefits. We access payer portals to get you authorizations, and we help you stay current.
Month to month. No contracts. Keep us around if you're happy.
We use a 100% secure, encrypted HIPAA protected communication channel to send you all patient data.
We verify all patient benefits & obtain pre-authorizations, so you can discuss payment options with patients before beginning treatment.