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Precise Eligibility and Benefit Verification Services

Maximize reimbursements. Eliminate rejections and denials.

Insurance Eligibility Verification Services and Prior Authorization

Ensure success by leveraging automated eligibility and benefits verification services prior to medical services. Our team manages insurance verification and prior authorizations, streamlining the billing process.

Insurance Eligibility

Ensuring swift verification of patient insurance coverage with all payer types, maintaining up-to-date patient account records.

Benefits Verification

We ensure all patient details are up-to-date, covering benefits, deductibles, and policy status.

Referral Authorizations

We track and document the criteria for authorization or referrals to prevent revenue loss.

Accurate Documentation

Detailed and accurate documentation of all benefits, facilitating hassle-free billing.

Deductibles, Co-pays, and Co-insurance

Ensuring accurate calculations of patient deductibles, amounts met, and co-pays or co-insurance.

Efficient Workflow

Improve patient outcomes and boost revenue through our streamlined and efficient workflows.

Eligibility & Benefits Verification FAQ’s

What details are included in the eligibility coverage information?

We verify details like coverage, copayments, deductibles, and coinsurance with the patient’s insurance provider. This process may also include checking for additional insurance coverage, the primary care provider (PCP), and the patient’s eligibility status.

At what point is eligibility verified?

We ensure billing alerts are provided at least 48 to 24 hours before the patient’s appointment and that demographic information is reported accurately.

What are the best practices for eligibility verification?

To reduce denials, accounts receivable (AR) days, and revenue delays, verifying patient eligibility and benefits is essential. Confirming patient coverage before a visit facilitates timely collections. We identify and flag inactive plans, verify primary, secondary, and tertiary insurance, and check which services are covered under the patient’s policy. Additionally, we determine if a referral or prior authorization is required.

What process do you follow for eligibility verification?

Most payers provide online interfaces for checking eligibility electronically before the scheduled patient appointment. However, it may occasionally be necessary to contact the payer directly to address questions about prior authorization requirements or to clarify specific aspects of eligibility and benefits.

What do our clients say?

MedRevenue Systems has been an incredible asset to our private practice, and I want to express my gratitude for their professional support over the past two years. I deeply appreciate their assistance with medical billing services, including eligibility and benefits verification, especially during the challenging time when our office manager, Jani, left. Since then, our partnership has been smooth and problem-free.

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