ELIGIBILITY VERIFICATION
Our Eligibility and Benefits Inquiry system enables health care professionals to request patient eligibility status instantly and securely. Making your daily interactions with us convenient and easier.
Find benefits information with ease; We include all these information right on your eligibility inquiry:
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Member ID, group number, and plan number/plan name
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Active coverage, original effective date of coverage or termination date
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Insurance type and product type
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Access to a patient’s digital member ID
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Detailed financial information, including remaining, deductible, copayment and coinsurance for individual and family levels
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Lifetime, annual maximum and remaining dollar amounts
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Exclusions, plan limits and remaining amounts
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Coordination of benefits (COB) information, wherever applicable.
Four Easy Ways to Check Patient Insurance Eligibility
1: Insurance Websites
One of the simplest methods is to go directly payer portals. Insurance companies like Blue Cross Blue Shield, Aetna, or United Healthcare allow providers to enter information directly into their portal. Look for “Member Services” or “Provider Portal” to find the payer’s eligibility and benefits tools.
2: Through a Clearinghouse
If your practice management system accepts many different insurance plans and providers, you may want to explore more centralized option. Tools like Availity, pVerify make it possible to check a larger number of payers in a single portal. This allows providers to get information from multiple payers in one place rather than operating in multiple different portals or websites.
If you use a clearinghouse to submit your claims to an insurance companies, it’s likely your clearinghouse has some sort of eligibility verification tool. This process may not go deep enough to give you detailed benefits, but you will get at least the basics of what you need for eligibility verification.
3: Check eligibility through your software
Practice Management System (PMS) can check a patient’s eligibility before their visit or generate an eligibility check instantly if you need a quick response. PMS can provide a detailed verification of eligibility so you can provide coverage and copay information to your patients immediately.
4: Call the Payer
If you’re more old age school, you can call the payer directly. Most often you will get the payer’s interactive voice response system (IVR). This is an automated system when you call to an insurance company. This IVR will go through list questions to confirm information to provide the basics of that member’s eligibility.
It is possible to speak with a human at an insurance company. However, this takes an enormous time if you consider hold times are incredibly long. Most insurance companies aren’t putting many resources here, so expect hold time to continue to increase.