Insurance and Eligibility Verification
According to industry sources, 75% of all claim denials are because a patient is not eligible for services billed to the insurer by the provider. Often, a patient would be ineligible for benefits because his or her policy has been terminated or modified.
Pacific can help practices dramatically reduce their accounts receivable cycle and increase revenue, by significantly reducing the impact of ineligibility, and increasing the number of "clean" claims that are sent to insurers (i.e., claims that are both complete, and are only for patients who are eligible for benefits). Unfortunately, eligibility verification is one of the most neglected elements in the revenue cycle.
In the absence of proper eligibility and benefits verification countless downstream problems are created; delayed payments, rework, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, PACIFIC provides a remotely hosted Centralized Eligibility Unit for Hospitals and Faculty Practice Plans. The solution consists of PACIFIC deploying staff, technology, management and expertise with the objective of delivering high-quality cost-effective patient insurance eligibility and related services.
Pacific 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
Our 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, copay information and much more.
Related Services (optional):
- Obtain Pre- Authorization Number
- Obtain the 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.