Understanding Eligibility & Benefit Verification Workflow for Healthcare Providers
Eligibility and benefit verification is a critical step in the revenue cycle that ensures patients’ insurance coverage is confirmed before services are rendered. This process reduces claim denials, enhances patient satisfaction, and improves revenue collection.
Gather patient demographics, insurance details, and policy numbers during appointment scheduling. Ensure all data is accurate to avoid verification issues.
Patient Information Collection
Real-Time Insurance Verification
Check patient eligibility through payer portals or clearinghouses. Confirm active coverage, policy status, and plan limitations.
Determine patient financial responsibility, including co-pays, deductibles, and co-insurance. Provide transparency on costs before service delivery.
Store verified eligibility details in the EHR and billing system. Maintain compliance with payer requirements and audit readiness.
Inform patients about their coverage details, estimated costs, and payment options. Offer payment plans if needed to reduce financial burdens.
Ensure that the provider is in-network with the patient’s insurance plan. Prevent out-of-network claim denials and unexpected patient expenses.
Identify procedures requiring prior authorization or specialist referrals. Submit necessary requests to payers and follow up for approvals.
Co-Pay, Deductible, & Out-of-Pocket Calculation
Patient Notification & Financial Counseling
Prior Authorization & Referral Verification
Documentation & Record-Keeping
Provider Network Confirmation
Our Success In Numbers
We are dealing with the clients since a long time
$125M+
Value of Claims Processed
Since 2019
99%
Total Revenue Collected
24
Accounts Receivable Days
48 Hours
Turn Around Time
1,000,000+
Number Of Claims Processed
99%
Customer Retention
98%
First Pass Clean Claim Rate
15-20%
Revenue Improvement
26 Days
Turn Around Time For Payment
35%
Reduction In Accounts Receivable
Preventing Claim Denials and Enhancing Revenue Cycle Efficiency
Accurate Insurance Verification to Minimize Claim Rejections
Insurance eligibility errors are one of the leading causes of claim denials, contributing to delayed payments and increased administrative workload. According to the American Medical Association (AMA, 2023), nearly 20% of all claim denials are due to incorrect or outdated insurance information. Our eligibility and benefits verification services ensure that patient coverage details are accurately confirmed before services are provided, preventing unnecessary claim rejections and financial losses. We conduct real-time verification of patient insurance status, policy coverage limits, deductibles, co-pays, and pre-authorization requirements, ensuring that providers have the correct billing information upfront. By integrating automated verification tools with electronic health records (EHR) and billing systems, we reduce manual errors and streamline the insurance validation process. Healthcare organizations that utilize our services report a 25% improvement in claim approval rates and a significant reduction in administrative burdens. By proactively confirming insurance details before treatment, we help providers optimize reimbursement processes and maintain steady cash flow.
Reducing Administrative Burden and Enhancing Patient Satisfaction
Manual eligibility verification is time-consuming, often leading to delays in patient check-ins, billing disputes, and unnecessary financial stress for both providers and patients. Studies by the Healthcare Financial Management Association (HFMA, 2023) indicate that automating eligibility verification can reduce front-office administrative workload by up to 30%, allowing staff to focus on patient care rather than insurance complexities. Our solutions provide real-time updates on insurance coverage changes, ensuring that providers always have the most accurate eligibility information. Additionally, we assist in obtaining prior authorizations, ensuring that all necessary approvals are secured before services are rendered. This proactive approach minimizes claim denials, accelerates reimbursement cycles, and reduces payment delays. Patients benefit from transparent financial communication, as they are informed about their financial responsibilities before receiving treatment, reducing billing disputes. By leveraging our eligibility and benefits verification services, healthcare organizations can improve operational efficiency, enhance patient satisfaction, and achieve higher financial stability.
Call Us Now | +1 (323) 412-5399
Call Us Now | +1 (323) 412-5399
Reduces claim denials due to coverage issues.
Ensures compliance with payer and regulatory requirements.
Enhances patient experience with upfront cost transparency.
Speeds up billing and reimbursement processes.
BENEFITS OF AN EFFICIENT ELIGIBILITY & BENEFIT VERIFCATION PROCESS
Prevents revenue loss from unpaid claims.
Call Us Now | +1 (323) 412-5399
What Our Clients Say?
Evo Care Medical Billing has been a game-changer for our practice. Their expertise in Chronic Care Management (CCM) helped us significantly increase patient enrollments, resulting in an incredible 233% revenue growth within six months. Their team streamlined our workflow, improved patient engagement, and ensured compliance, making a lasting impact on our success. We highly recommend their services to any healthcare provider looking to optimize billing and patient care.
Diane Baucom- Chronic Care Manager - AIMS Florida
Earn more and get paid faster with Evocare Medical Billing's 24/7 services.
Evocare is a medical billing provider that integrates with your existing EHR system for streamlined processing.
We are honored to offer top-tier service with a 99% retention rate that sets us apart.
