Let’s face it.

No one likes dealing with insurance eligibility verification — not healthcare providers like you, your staff or your patients. The process can be confusing for patients and frustrating for staff. It involves thousands of moving parts, yet it’s crucial to your bottom line.

Beyond securing your revenue cycle, a seamless verification process leads to happier patients. And when word gets around that your practice provides distinctly patient-centric care, your patient acquisition strategy grows stronger.

So, how do you untangle the knots?

Here’s how to streamline your insurance eligibility verification process, from gathering initial patient information to conducting follow-ups.

[Related: How Patient Journey Mapping Revolutionizes Your Healthcare Experience]

How To Smooth the Health Insurance Eligibility Verification Process

We’ve compiled five tips that help take the strain out of checking a patient’s eligibility. Some may seem like common sense, but following these pointers is still key to avoiding costly snags and payment delays.

1. Offer Self-Service Options

Patients appreciate autonomy in their healthcare. Offering avenues like patient portals, secure text messaging and appointment-scheduling apps puts the power in their hands.

Naturally, that appreciation extends to their insurance eligibility verification.

On that note, self-service software gives patients a digital means to see, change and correct their insurance information. As a result, they stay in the loop and (hopefully) don’t face unexpected charges and coverage shifts. And that means greater patient satisfaction!

This tip carries a major secondary benefit — every patient who verifies their own insurance lightens your staff’s workload. When patients have a 360-degree view of their healthcare insurance, your staff members have far fewer phone calls to answer.

[Related: Automated Medical Answering Services: Are They Worth It?]

2. Collect All the Information You Can, Now and Later

You and your staff already know the basics. You get a patient’s insurance card, ID, contact information and payment method when they enter the office. But for smoother medical insurance eligibility verification, start getting information ASAP.

When a patient schedules an appointment — over the phone or online — have staff request their insurance data. Checking that patient’s insurance coverage becomes instantly easier.

You need in-person verification regardless, but knowing their provider and plan lets staff check for gaps and estimate co-pays. To boot, they can reach out to insurance providers beforehand to ensure a plan covers your medical services.

Then, recheck a patient’s insurance information every time they visit your practice. It might seem excessive, but so are claim denials and all the ins and outs of healthcare insurance.

[Related: Top 13 Benefits of Hiring a Virtual Assistant]

3. Keep Your Records Up to Date, 24/7

This tip ties to the one above — every time you recheck a patient’s insurance information, recheck your records. With evolving plans, regulations and guidelines, it’s a smart move. And of course, always document any changes in your system — a track record may come in handy down the line.

As an extra safeguard, it never hurts to go above and beyond.

Have staff record the date, time and reason patients contact your clinic, even if they don’t explicitly mention insurance coverage. Those seemingly minor details may tip the scales in your favor if complications like claim denials arise.

Pro Tip

AI tools, like a virtual medical scribe and web widget, take the guesswork out of getting those granular details exact.

An AI-powered solution like Wendi automates the patient journey, lives on every page of your website, captures contacts and records phone/text data. Real-time insurance eligibility verification is one of its many specialties.

Checking a patient’s insurance coverage is a built-in feature, simplifying your revenue cycle.

[Related: How To Run a More Efficient Practice With a Virtual Healthcare Front Office]

4. Educate Patients, and Train Staff Regularly

The “knowledge is power” adage holds true. If patients and staff don’t know your system’s capabilities, then they can’t use it to its fullest.

So for better insurance eligibility verification processes, talk to the people you count on most to give and gather that information:

  • Let patients know their options. Helpful patient education includes info about virtual (self-service) capabilities, available communication channels and insurance-related tools. A patient’s insurance coverage information often lies at their fingertips.
  • Train staff on your systems and software. Hold regular conversations with your staff about what systems you use, what those systems can do and what they should record. Even when staff know the core verification steps, a patient’s eligibility can change.

For example, let’s say you’ve adopted AI insurance-checking software at your practice. If you tell patients and staff how it handles medical insurance eligibility verification, you save everyone significant time and confusion. All the while, you save your practice money.

[Related: 5 Patient Engagement Strategies for Your Healthcare Practice]

5. Update Your Practice’s Software With AI

This is no small fry. An AI-powered software solution can make all the difference between raising revenue and dealing with piles of complaints and complications.

Integrating insurance eligibility verification software into your practice is your cleanest, smartest route to streamlining the process. With access to insurance databases, patient information and HIPAA guidelines, it draws a clean line between your patients’ insurance and your practice.

Besides the clear advantages that automation offers, here’s what real-time insurance eligibility verification brings your practice:

  • More satisfied patients. AI software mitigates surprise charges and serious disappointment if their insurance doesn’t cover one of your medical services. The patient’s eligibility is apparent.
  • More productive staff. Your staff members don’t have to comb through plans, patients and healthcare providers to find who covers who — and for what procedures. Ultimately, your revenue cycle is less complex.
  • More profit. You ensure you receive payment — and reduce payment delays — with fewer errors, fewer claim denials and more clean claims.

Most AI-based software integrates with your existing systems, so training is a snap. And if cost is a concern, don’t worry. An around-the-clock AI assistant like Wendi costs as much yearly as one employee’s monthly salary.

[Related: Considering Using AI in Your Healthcare Practice? Here’s Where To Start]

Get Powerful Insurance Eligibility Verification Software With Wendi

Skip the headache of verifying eligibility the antiquated way. Meet Wendi — our comprehensive AI assistant for healthcare providers.

Wendi crawls a broad database of more than 1,800 payers. Plus, Wendi-supported insurance providers cover more than 96% of current and potential patients!

Its real-time insurance eligibility verification capabilities make checking a patient’s coverage simple. Your patients know their benefits and costs within seconds, while your staff members have less legwork.

Schedule a demo to see how Wendi works for you. Contact us anytime to discuss how insurance verification can be a breeze!

Featured image via Pixabay

Published On: December 11, 2023Categories: Healthcare

Recent Posts

Wendi AI-as-a-Service

AI-powered healthcare management automation for all practice types