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To summarize, insurance verification is an initial step to confirm that a patient has valid insurance and to understand the coverage details, while insurance authorization is a subsequent step for certain services that require pre-approval from the insurance company.
Collect the patients insurance information. The patients name and date of birth; The name of the insurance company; The name of the primary insurance plan holder and their relationship to the patient; The patients policy number and group ID number (if applicable); and.
Preventing Claim Denials: Insurance verification helps identify potential issues that may lead to claim rejections and allows for timely resolution, reducing the risk of claim denials and maximizing reimbursement rates.
You will receive an Explanation of Benefits (EOB) that details how the medical care youve received is being paid by your plan. Around the same time, your doctor may send you a final bill for services. (Tip: Dont mistake your EOB for a bill.)
If the request is made over the telephone or in writing, verification may be accomplished by requesting identifying information such as address, telephone number, birth date, and/or medical record number and confirming that this information matches what is in the patients record.
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As mentioned, its no longer good enough to verify eligibility once a yearin fact, most recommend running a bulk verification every month or so, in order to catch any changes in your patients insurance coverage or deductible levels.

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