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Eligibility and Benefits Verification

A Critical Component to Revenue Cycle Management

Insurance eligibility verification and plan-specific benefits information confirmation before services are rendered not only leads to fewer claim rejections and denials, but it also lays the foundation for an effective patient financial counseling program.

In fact, it’s not unusual for an employer to change employee health plan offerings each year, or for employees to switch plans annually, as each group looks for ways to reduce expenses. These frequent, ongoing changes increase the importance of accurate, upfront eligibility and benefits verification for all healthcare providers.

With Experian Health Eligibility and Benefits Verification, healthcare organizations can electronically validate patient co-pay, benefit and deductible information at any point in the billing process via batch or real-time insurance checks with an extensive payer network.

Improve Cash Flow

Having access to the most up-to-date eligibility and benefits data increases clean claims rates, eliminates costly rework and accelerates reimbursement. When leveraged in combination with Experian Health Patient Responsibility Pricer – a tool that estimates a patient’s out-of-pocket financial obligations based on the latest payer contract terms – healthcare organizations can take advantage of a fully integrated insurance and benefits verification offering that increases time-of-service collections, minimizes bad debt and boosts patient satisfaction.

Streamline Workflow

Eligibility responses are viewed in a concise and consistent format that improves efficiency. Providers apply custom business rules and analytics to returned payer data, and automatically receive notifications when edits or follow-up are required.

Boost Self-Pay Revenue

Capitalize on additional reimbursement opportunities by electronically matching self-pay patients against Medicaid and Managed Medicaid databases. After identifying any individuals who may unknowingly have coverage, providers can reclassify these patients and submit claims, which is often the quickest way to secure payment.

Additional benefits include:

  • Decreased A/R days
  • Cleaner billing system data
  • Reduced registration, co-pay and billing errors
  • Lower billing and collections costs
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