Meeting Insurance Eligibility & Benefits Verification Challenge

Reduction in Staffing

80%

$42 Million Resolved

$12M Reduction + $30M Inflows

Reduction in Coverage Query Fees

50%

REQUIEMENT

As part of their ongoing commitment to enhancing underlying processes and procedures, the client desired to implement a shortened eligibility verification procedure that produced improved outcomes. This would guarantee that claims are handled appropriately from the beginning, without generating significant delays in client payments.

    
            KEY         
         DIFFICULTIES

Streamline complicated, time-consuming procedures for validating patient insurance coverage across a vast network of healthcare providers.

Reduce administrative and direct expenses associated with verification of insurance coverage.

Reduce write-offs in order to increase income.

Implement a system that can be altered rapidly to suit specific needs.

    
            OUR        
         SOLUTION

We created a multifaceted plan to simplify the insurance eligibility and benefits verification process for our clients. This is summarised as follows:

A specialized verification team was assigned to the account. The specialised team of qualified and experienced verification specialists served as a supplement to the client's front office personnel.

All walk-in patients' verification was completed one hour prior to their scheduled appointment.

We prepared documentation and guides for rapid, prompt, and accurate verification and built a verification procedure that assured verification was completed at least 48 hours before planned appointments.

Obtaining Swift Authorizations and Referrals from insurance companies.

Issues with insurance companies were promptly handled and resolved.

CASE STUDY