Verification of Benefits

Purpose

To ensure the proper procedure is utilized when verifying patient benefits and reviewing denials related to the patient’s policy benefits.

Policy

It is the responsibility of the clinic to verify insurance coverage and benefits.

A patient’s insurance benefits can change over time for a variety of reasons. To help ensure that the services to be rendered are covered, it is highly recommended that the clinic verifies every patient’s benefits at, or prior to, each visit. Failure to verify benefits and engage patients early in the process can lead to lost revenue for the clinic.

The clinic should use the Verification of Benefits checklist to ensure that all pertinent information has been obtained. This process should also be followed for all payers listed in the payer mix, including secondary, tertiary, etc.

If no other coverage is found, the claims will be moved to the next level responsible party (secondary or patient responsibility). If alternative coverage is identified in the account, the claim will be refiled to the appropriate payer.

Benefit related denials will be reviewed to ensure no false denial is received during post claim adjudication. The accounts receivable representative will review the patient’s account to see if any other policy information is documented.

Clinicient offers eVerification to expedite the process for the clinic. While eVerification does not provide all benefit level information, it will provide a basic understanding about whether the patient is active or inactive with a payer.

Verification of Benefits Definitions

Verification of benefits is the process of verifying the patient's active medical coverage/benefits with the insurance company. Verifying patient’s benefits is critical in the successful resolution of a claim because insurance may not cover certain services, even if the patient shows they have active coverage.

 

Clinicient (the “Company”) is providing this information for general guidance. The application, impact and change of laws can vary widely. Accordingly, the information is provided with the understanding that it is not offered as legal or any other professional advice or services and as such should not be used as a substitute for consultation with professional and licensed advisers. While we have made every attempt to ensure that the information contained herein is accurate at the published time, the Company is not responsible for any errors or omissions, or for the results obtained from the use of this information. All information is provided "as is," with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance and fitness for a particular purpose. In no event will the Company or its subsidiaries, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information.

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