Eligibility Verification

Eligibility Verification Overview

OOften, a patient would be ineligible for benefits because his or her policy has been terminated or modified. AHCBS can help practices dramatically reduce their accounts receivable cycle and increase revenue by significantly reducing the impact of ineligibility and increasing the number of "clean" claims that are sent to insurers (i.e., claims that are both complete and are only for patients who are eligible for benefits).

Unfortunately, eligibility verification is one of the most neglected elements in the revenue cycle.

Eligibility Verification Process Flow:

  • STEP 1: Checking and verifying the patient's insurance eligibility and benefits prior to the treatment.
  • STEP 2: Checking with the insurance company regarding any payment responsibility the patient needs to fulfill prior or post the treatment. This is done by our team of expert telecallers two days prior to the patient's appointment date.
  • STEP 3: Informing the patient of their payment responsibilities at the time of appointment scheduling. This step is beneficial to both the patient and our clients. It helps the patients decide on the course of treatment and the client to avoid last minute cancellations due to ineligibility reasons.
  • STEP 4: The appointment confirmation process is particularly helpful for the client and patient as it negates last minute schedule changes and saves time for the front desk staff, thereby increasing overall efficiency.

Benefits from AHCBS Eligibility Verification Services:

  • Fewer Denials: AHCBS services manages both primary and secondary insurances to ensure that billing is correct and has been sent to the proper payer, resulting in fewer claim denials..
  • Reduction in A/R Days:The system not only validates that the patient has coverage but also has the ability to submit outstanding invoices for eligibility verification purposes. This helps ensure accurate billing, eliminating the need to resubmit claims, and reducing the number of days from billing to collection.
  • Increased Cash Flow: Access to correct billing information means increased upfront collection of patient fees and fewer resources required for billing and collections, freeing up cash for other functions.
  • Enhanced Efficiency: Automating the eligibility process streamlines workflow, reduces paperwork, and enhances billing accuracy; meaning less staff time is required for billing and collections.
  • Decreased Collection Calls to Patients: Because patients are aware of their coverage, co-pays, and deductibles at the time of service, misunderstandings are minimized, resulting in fewer payment delays and less need for billing follow up.
Client Testimonial

We have used AHCBS from the start of our practice in March 2008. Being new to the billing aspect of the medical field myself, I have found AHCBS to be very helpful in guiding us with helpful, knowledgeable information. They are prompt and professional and have proven to be an asset to our company.
Nate Brennan, DPM, Oneida, Tenn.

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