Missed or Incorrect Insurance Eligibility Verification
The process of Insurance Eligibility Verification is crucial to ensure denials due to missed or incorrect information are under control. There can be several reasons for claim denial or rejection but researches have proved not having an effective Insurance Eligibility Verification is the major reason for most denials and claim rejections comparatively. Let us discuss the complete checklist for Insurance Eligibility Verification to make it more efficient and streamlined to improve the overall billing experience.
Common Denials Due to Missed Insurance Eligibility Verification: –
- Claim denied due to typo in the mandatory information
- Lack of mandatory information
- Incorrect or incomplete Patient Demographics Entry
- Coverage exhausted
- Service not covered
- Coverage terminated
- Policy Terminated or Expired
- Service requires Prior Authorization or referral
- Out-of-Network coverage
Insurance Eligibility Verification is greatly beneficial to identify and curb denials as listed above which is not exclusive but also more such possibilities and helps cleaner claims submission with increased first-pass rate. Therefore, it is essential for any medical Billing and Revenue Cycle Management services to have a full-fledged Insurance Eligibility Verification. The best way to achieve maximized benefits is to have a checklist for a streamlined Eligibility Verification process.