PATIENT SERVICES

IN-NETWORK & OUT-OF NETWORK BENEFITS CHECKING

Improper eligibility checking is the number one cause for claim rejections. Therefore, Eligibility checking is the single most effective way of preventing insurance claim denials.

Our team of Eligibility & Benefits Verification work on this process with the insurance provider.

The service begins with retrieving a list of scheduled appointments from Provider’s office via Email/ Fax / FTP and verifying insurance coverage for the patients, from all Primary and Secondary Payers by utilizing Payer websites, Automated voice responses and Phone calls to Payers to verify if the patient has active or inactive coverage. We also use a combination of monthly eligibility/capitation lists and contact patient for information when necessary.

We generate results to include information such as member ID, group ID, coverage start and end dates, co-pay updates, deductibles being met or any specific procedures such as vaccine administration are covered.

In other cases we obtain Pre-Authorization Number, Referrals from PCP, and inform clients if there is any issue with coverage or Authorization.

Once the verification is done the coverage details are put directly into the appointment scheduler for the office staff’s notification.

The verification team ensures that every new or continuing patient’s verification is completed before his arrival the healthcare facility. This proactive approach helps in following the rules required by the payer, for the patient to understand his financial obligations and validating the payment to be received from the patient and/or payer.

The patients appointment scheduling service is offered to provide doctors a convenient way to maximize their use of business hours across facilities and on a consistent basis.

Scheduling is done as per the requirements of the office which include working hours, total providers, procedure type, locations, etc… it can be organized centrally. The actual appointments are scheduled directly into the provider’s Practice Management system. For patients that are “no shows” or have missed their appointments a reminder call can be given on a routine basis to reschedule their appointment with the office. Also recall lists generated based on certain medical conditions can also be used to schedule patient visits. Appointment reminders are done by calling patients at a preset time before the scheduled visit. The disruption due to cancellations is seamlessly minimized.

We take utmost care to optimize daily patient flow thereby increasing revenues to your practice.

For Specialists who requires a referral or a pre-authorization form the process starts with retrieving the patient demographic information, insurance coverage, procedures to be authorized, and details of the provider to which they will be referred.

Our Precertification service complements Eligibility and Benefits verification. Certain Referrals and Prior Authorizations are required by the patients’ health insurance plans.

The precertification team provides protocols for patient services requiring precertification. The protocols include the patient demographic information, insurance coverage, procedures to be authorized and details of the provider to whom they will be referred.

Once the referral is submitted tracking will be done to insure that the patient will be authorized to see the specialist on their designated appointment. This service also allows for emergency referrals on the date of service as needed by the office. A major advantage of pre-certification is the decrease in denials for non-authorized care thereby leading to reduction in bad debts.