Facebook
Linkedin
Instagram

Eligibility and Benefit Verification

The primary reason for claim denials is because a patient is not eligible for services billed to the insurer by the provider. BuiltAbility RCM helps healthcare providers reduce their accounts receivable cycle and increase revenue by reducing denials on account of ineligible patients.

ISSUES ON ACCOUNT OF LACK OF STRONG ELIGIBILITY AND BENEFITS VERIFICATION PROCESSES:

  • Reduction in clean claims ratio
  • Claim denials and consequently rework.
  • Delays in payment from healthcare payers
  • Reduction in the profitability of the practice
We deploy the people, technology and apply our experience to ensure accurate determination of insurance eligibility. Our services include:
  • Receive Patient Schedules from the healthcare provider.
  • Verify coverage on all primary and if applicable secondary payers by utilizing payer websites, and IVR systems.
  • As required, we make calls to payers to check the eligibility status and patients for additional information.
  • Update the results on the practice management system – update member ID, group ID, coverage start and dates, copay information and much more.
  • We also provide additional services such as reminding the patient of the POS collection required, obtaining referrals from Primary Care Physicians (PCPs)
Our comprehensive prior authorization services ensure that your patients get timely care while ensuring that you get paid for the services you provide.
  • The documentation requirements vary by payer. We prepare prior authorization requests in payer-specific formats.
  • We follow-up on submitted requests in a timely manner.
  • Update the revenue cycle systems on the status of the prior authorizations.
  • Improve speed to care for patients waiting on eligibility verification, particularly for procedures that require prior authorization.
  • Improve clean claim submissions.
  • Reduce days in A/R
  • Improve collections and profitability.
  • Reduce costs by as much as 50% through offshore delivery.

Contact Us

    x