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Eligibility Verification Services

At Prominent MD, we understand that accurate eligibility verification is a critical component of the medical billing process. Verifying a patient’s insurance eligibility before services are provided ensures that your practice gets reimbursed for the care you deliver and helps avoid claim denials or payment delays. Our Eligibility Verification Services are designed to help you streamline your workflow, minimize administrative errors, and ensure that patients' insurance coverage is active and valid, giving you peace of mind and helping you maintain a steady cash flow.

What is Eligibility Verification?

Eligibility verification is the process of confirming a patient’s insurance coverage and determining their benefits before services are rendered. This step helps healthcare providers verify that the patient’s insurance plan is active, covers the needed services, and meets the requirements for reimbursement. Verification typically includes confirming key details such as:
  • Insurance carrier and plan type
  • Coverage start and end dates
  • Co-pays, deductibles, and co-insurance amounts
  • Pre-authorization or referral requirements
  • Provider network status (in-network vs. out-of-network)
By confirming this information before providing care, your practice can avoid unnecessary billing issues and ensure that patients are aware of their financial responsibilities.

Our Eligibility Verification Services Include:

Real-Time Eligibility Checks:

We use advanced software and tools to verify insurance eligibility in real time, ensuring that you have up-to-date information on the patient’s coverage at the point of service. This minimizes the risk of errors and improves workflow efficiency.

Phone and Online Verification:

Our team is well-versed in verifying eligibility through both phone calls to insurance companies and online portals. Whether it’s through provider portals or direct phone communication, we ensure that all necessary details are confirmed before treatment is provided.

Detailed Verification Reports:

We provide detailed reports outlining the eligibility status, including co-pays, deductibles, and any required pre-authorizations. This allows you to inform patients of their financial obligations upfront and avoid billing surprises.

Pre-Authorization Management:

If your services require pre-authorization, we handle the process for you. We ensure that all necessary approvals are obtained from the insurance company before the patient receives treatment, preventing any delays in reimbursement.

Coordination of Benefits (COB):

We assist in determining the correct payer when patients have multiple insurance plans. By coordinating benefits between primary, secondary, and tertiary payers, we ensure accurate billing and maximize reimbursement.

Out-of-Network Verification:

If a patient is out-of-network, we confirm their coverage details and benefits to ensure your practice can still submit a claim. We also provide clarity on any out-of-pocket costs that the patient may need to cover.

Verification for All Types of Payers:

Our eligibility verification services cover all types of payers, including Medicare, Medicaid, private insurance companies, and employer-sponsored plans. We ensure that you have the most accurate information for all insurance types.

Pre-Scheduled and On-Demand Verifications:

We offer both pre-scheduled and on-demand verification services to suit your practice’s needs. Whether you prefer batch verifications before patient visits or need ad-hoc eligibility checks on a case-by-case basis, we’ve got you covered.

Why is Eligibility Verification Important?

Avoid Claim Denials:

Ensuring that the patient’s insurance is active and that they are eligible for the planned services helps prevent claim denials. Verification before services are rendered reduces the risk of unpaid claims.

Improve Cash Flow:

With accurate eligibility information, you can avoid unnecessary delays in reimbursement, which helps maintain a consistent and healthy cash flow for your practice.

Enhanced Patient Communication:

By verifying eligibility in advance, you can inform patients about their coverage and any out-of-pocket expenses, reducing confusion and improving patient satisfaction.

Time and Cost Efficiency:

Streamlining the eligibility verification process reduces the amount of time your staff spends on billing-related tasks, allowing them to focus on other important aspects of patient care and administrative tasks.

Compliance with Insurance Regulations:

Proper eligibility checks help ensure that your practice complies with payer guidelines and reduces the risk of audits or legal issues related to improper billing.

Why Choose Our Eligibility Verification Services?

Accuracy and Efficiency:

We leverage advanced tools and experienced staff to provide accurate and real-time eligibility verification, minimizing errors and reducing delays.

Cost Savings:

By ensuring that insurance coverage is verified in advance, your practice can avoid costly errors, such as submitting claims for services that aren’t covered or facing delays due to missed coverage details.

Improved Patient Experience:

With clear communication about coverage and patient financial responsibilities, you can reduce confusion and improve patient satisfaction and trust.

Experienced Professionals:

Our team is well-versed in insurance verification protocols across a variety of payers, including private insurance, government programs like Medicare and Medicaid, and employer-sponsored plans.

Comprehensive Coverage:

We verify eligibility for all types of insurance plans, including PPOs, HMOs, Medicare, Medicaid, and managed care plans. Whether your patients are insured through an employer or a government program, we handle it all.

Scalable Services:

We can tailor our eligibility verification services to fit the specific needs of your practice, whether you are a small private practice or a large healthcare network.

The Benefits of Proper Eligibility Verification:

Reduced Claim Denials:

By verifying coverage and benefits before providing services, you ensure that claims are more likely to be accepted, reducing the risk of denials or rejections.

Faster Payment:

With accurate eligibility data, you can submit clean claims that are processed more quickly by insurance companies, resulting in faster payment for your services.

Reduced Financial Stress for Patients:

With clear communication about out-of-pocket costs, co-pays, and deductible responsibilities, patients will know what to expect, reducing the chances of disputes and dissatisfaction.

Better Resource Management:

By using eligibility verification services, your staff can focus on patient care and other important administrative tasks rather than managing billing discrepancies and chasing down missing information.

Get Started with Eligibility Verification Today

At Prominent MD, we provide comprehensive Eligibility Verification Services that help your practice reduce errors, improve reimbursement timelines, and provide a better experience for your patients. We handle the tedious and time-consuming process of verifying insurance eligibility so that your practice can focus on what matters most—delivering excellent care to your patients.
Contact us today to learn more about how our eligibility verification services can streamline your billing process and improve your practice’s financial health.