One of the most common denials practices face is “Member eligibility not found on this Date of Service” or “Patient eligibility not found with Entity”.  It is imperative that a provider verifies a patient’s insurance coverage before any services is provided. This small step could save the practice from a reduction in the revenue.

Verifying a patients eligibility by the practice before the service is rendered doesn’t just provide patients updated insurance information but helps in identifying self-pay patients as well. Submitting claims without verifying patient eligibility could increase your denial rate if the patient’s eligibility coverage with the insurance is not according to what is on the claim. Not checking the patient’s coverage with the insurance before filing a claim could result in

  • Delays in payments
  • Increased phone bills
  • Reduced reimbursements
  • Increase in AR Days
  • Timely filling write off (If the claim is not caught on time). To name a few

Prepare a checklist of information to look for when verifying insurance eligibility. Confirm the Member ID, Start and end date of Coverage, Lapse in coverage and Patient’s name as per ID Card. Make sure to verify benefits in case of Motor Vehicle Accidents. Rigorous verification of coverage results in one denial eradicated for the provider which in turn increases reimbursement.