How This Works - Patient Benefits Verification Done-For-You

Pre-Authorization & Pre-Certifications Done-For-You

10 Mistakes to Avoid with Patient Benefit Verification & Preauthorizations / Precertifications

Online eligibility verification is a tempting shortcut, but ultimately counterproductive. Online portals and EMRs can only retrieve limited data from insurance companies. As a result, they provide inaccurate and incomplete information. The solution - have us call the insurance company, ask all the right questions and spend as much time as needed to get you accurate, detailed patient benefits, pre-certification and pre-authorization information before you start treatment. You stop worrying about claim denials and slash your front desk workload by 50%. We become an extension of your clinic. The result - Happy patients, happy staff and less claim denials.

FACT - Benefit Verification with Online Portals & EMRs is Inaccurate & Incomplete; a Single Mistake Could Cost You Thousands of Dollars in Claim Denials

FACT - Insurance Company Reps on the Phone have Access to 3 Times More Data Than Online Portals, Data that is Absolutely Necessary to Get Your Claims Paid 

Not having accurate (and comprehensive) benefits information and pre-authorizations is THE number one reason for claim denials. Let's face it - no one enjoys calling payers to verify benefits. It's far more tempting to click a few buttons in web portals to get patient benefit verification data. However, this data is often incomplete, and a single mistake can cost you tens of thousands of dollars in claim denials. There are no shortcuts, and the only way to get the most accurate and reliable information is to ask a specific set of questions, and get a call reference number from the payer.  

Denial reasons include benefit caps, policy/coverage is no longer active, authorization denied, and denial for non-covered services. This results in payment rejections, and even permanent loss of income due to delayed or improper submission.  

Some clinics deal with this by having staff on the phone, for 30-45 minutes or more for each phone call, as they try to get answers from an insurance company.  

Others rely on technology for eligibility information online, but the information from online portals is not always accurate, and in most cases, incomplete.  

The good news - We present you with a new way that is cheaper, and more efficient.

We Slash Your Front Desk Workload by Up to 50%

You provide us with these data points about your patient: 

• First Name 
• Last Name 
• Date of Birth
• Address 
• Phone Number 
• Payer Name 
• Patient's Insurance ID
• Insurance Group Number 
• ICD-10, CPT codes and dates of service (for pre-authorizations) 

That's it.

Leave the rest to us.

No need to call the payers.

Focus on patient treatment and patient satisfaction. Get paid. We become an extension of your clinic.

We call the payer, and get you the following in a secure, encrypted manner, mostly within 2-4 hours. 

• Verification that the policy number and group number provided by the patient is 100% accurate
• Policy effective dates & current status
• Type of policy and services covered 
• Co-pay & Co-insurance 
• Deductible limit and utilization in current period
• Policy limitations 
• Therapy cap met / not met by the patient 
• Services that are excluded from coverage payment 
• Verification of paper claim mailing address and phone number 
• Claims adjusters name and phone number 
• Requirement for pre-authorization or referrals 
• Pre-authorization number, authorization effective date, authorizaton end date, number of visits approved, number of visits already used and approved CPT codes
• In network benefits (if the patient is in network)
• Out of network benefits (if the patient is out of network)
• Timely filing limitations for claim filing 
• Documentation requirements
• Date of call, name of insurance company rep and call reference number from the payer