Prioritize reimbursem*nts with automated eligibility checks
Between patients taking on more payment responsibility and new regulations like the No Surprises Act, healthcare providers are at higher risk than ever of claim denials, rising AR days, payment delays, and non-compliance. Plus, the manual process of verifying accurate coverage is manually intensive, error-prone, inefficient, and time-consuming. Using an automated process to verify coverage at the time of service will help you improve staff productivity while experiencing fewer payment delays and claim denials.
Let us help you verify coverage prior to service, so you can focus on providing the best care for your patients.
Improve cash flow
Reduce claims denials and speed of payments with automated insurance eligibility and benefits data.
Avoid costly rework
Find correct coverage the first time.
Unlock Medicare reimbursem*nt opportunities
Speed up Medicare reimbursem*nts with our automated MBI Lookup Service that returns missing or invalid MBIs along with its Medicare benefit coverage.
Gain staff efficiency
Keep up with increasing patient demand by leveraging automated work queues created with preset or custom alerts.
Reduce bad debt
Lower your risk of bad debt by verifying insurance in real time.
Increase patient satisfaction
Empower your patients with accurate payment estimates and accelerated registration.
Simplify your workflows
View eligibility responses in an easy-to-read format that notifies you when edits or follow-ups are required.
Find and rectify incorrect plan codes
Leverage eCare NEXT®'s Bad Plan Code (BPC) Detection to promptly alert and prevent costly denials for incorrect plan code usage on patient accounts.
Providence Health
- Reduced their denial rate and saved $18 million in potential denials in just 5 months
- Have found an average of $30 million in coverage annually
- Identifyingan increased amount of active eligibility, ensuring accurate reimbursem*nt and avoiding claim denial
Read full case study
Our search for a solution that seamlessly integrates withEpic led us to choose Experian as our preferred vendor,given their proven track record of working with Epic.
Providence Health
9,000
Live client sites
900+
Seamless payer connections
2.9B
Eligibility transactions in 2022
How patient eligibility verification and MBI work together
- Eligibility clearinghouse:Connect to 900+ payers, with backup connectivity to minimize payer-specific service interruptions.
- Normalization:View patient information in eligibility responses across all payers.
- Data enrichment:Unlock intelligence and detailed responses from payer websites and other accurate sources.
- Search optimization:Find patient matches with certainty.
- CAQH COB Smart® data:View primacy information for relevant transactions to increase accuracy and streamline your processes.
- MBI Lookup Service:Improve Medicare reimbursem*nt rates by automating MBI lookup and eliminating manual inquiries.
Learn more about our Medicare Beneficiary Identifier (MBI) Lookup Tool
Learn more
Frequently Asked Questions (FAQs)
What is an eligibility check?
An eligibility check or health insurance lookup ensures patients have active medical insurance coverage. It verifies different aspects like insurance status, coverage details, and benefits for medical services, making sure billing is accurate and providers can be reimbursed, which ultimately supports patients in accessing the care they need without financial burden or surprises.
What methods can be used to verify patient eligibility?
Methods include online portals, file batching, automated systems, and real-time direct communication with insurance providers. These streamline insurance verification software processes, making it easier for healthcare staff to confirm patients' coverage accurately. By releasing staff from time-consuming calls with insurance companies, patients receive the care they deserve without delays or confusion.
Why is it important to verify insurance eligibility and benefits?
Verifying insurance eligibility ensures accurate billing, reduces claim denials, and enhances revenue cycle management. By streamlining the verification process, claims are paid faster with no rework. It also prevents surprises for patients regarding coverage and financial responsibility, fostering trust and transparency in the healthcare experience, ultimately supporting positive patient-provider relationships and making sure all individuals have access to quality care.
How does incorrect eligibility verification impact claims denials?
Incorrect verification leads to denied claims, causing delays and revenue loss for healthcare providers. Accurate verification reduces claim rejections, streamlining reimbursem*nt processes, and improving financial outcomes for both providers and patients. By guaranteeing accurate eligibility verification, healthcare organizations can optimize revenue cycles, minimize administrative burdens, reduce denials with patient access solutions, and deliver seamless care experiences for all patients.
Deep dive into our eligibility process and workflow
Download product sheet
Insurance eligibility resources
How to maximize eligibility verification
Read how unprecedented industry changes continue to threaten healthcare provider cash flow and why organizations must focus on eligibility in the patient access process.
Download whitepaper
4 benefits of health insurance eligibility verification software
An automated solution that eliminates errors and reduces denials could pay big dividends across the revenue cycle. This article breaks down the key revenue-boosting benefits of health insurance eligibility verification software.
Read blog
Avoid the common eligibility verification errors that impact revenue
Having the righthealth insurance eligibility verification softwarecan make or break the healthcare revenue cycle.Here are 4 key issues to watch out for.
Read blog
How improved insurance eligibility verification drives claims engines
Verifying coverage earlier in the billing process withautomated eligibility verification softwareincreases the chance of submitting clean claims the first time.
Read blog
Medicaid coverage at risk
Learn more about Medicaid Redetermination and how you can determine coverage to Prevent bad debt and serve your Medicaid population.
Watch on-demand webinar
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*Access our Eligibility solution through the eCare NEXT®, OneSource®, BatchSource®, Premium EDI, or EDI interfaces.
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