Eligibility Verification

Few, if any, pieces of timely information are as important to maximizing both revenue and patient satisfaction as eligibility. By allowing an enterprise to proactively determine if a patient is eligible for services with certain payers, prior to services being performed, Eligibility Verification affords the opportunity to ensure appropriate reimbursement. Automating the eligibility inquiry, the application ensures patient verification, reduces registration time and prevents payment denials. Eligibility Verification may be administered via three interface types, each with unique merit.

The Automated Eligibility Interface generates inquiries in a real-time mode at the time of admission or registration. Without interrupting or adding to the user's process, benefit information is retrieved from the patient's insurance company via Internet connection. All data provided by the payer can be stored for future reference.

The Batch Eligibility Interface, as the name implies, sends requests in batches for appointments scheduled for the following day. The response is normally returned and ready for viewing or printing the following morning. The Batch Interface also allows for historical queries, which often uncover missed revenue that may be reclaimed.

The Manual Interface allows for input to be keyed into predetermined screens at the time of admission or registration. Responses are usually ready to be viewed and/or printed within 30 seconds. All responses are stored in a database where information may be viewed by the users as many times as they like without being charged for another eligibility request.

Whichever interface suits your enterprise's needs, you are certain to reduce registration time, create labor savings, receive eligibility verification on all patients, reduce denials, lessen errors and omissions, even keep your HIS up-to-date with accurate and consistent information.