Eligibility Verification

Call 201-430-5358 or Email support@eligibilityverification.com

Eligibility Verification. 8D Yacenda Drive, Morris Plains, NJ 07950

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Denial reasons include benefit caps, policy/coverage is no longer active, authorization denied, and denial for non-covered services.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

READY? LET'S TALK

Imagine a day in your clinic where every new patient had eligibility verification and pre-authorizations done and available to you, without a single member of your staff spending a minute on hold with an insurance company - all for a fraction of the cost of doing this in-house. Eligibility Verification is a powerful and effective service to combat claim denials for reasons such as 'non-covered service' and denials due to lack of eligibility and pre-authorizations.

A Happy Practice

You'll see lower denials and a happier, more productive staff. A happy practice makes more money.

Our service includes a summary of communication with the payer and provides you with all relevant information - in many cases, before a patient walks into your clinic.

We have a large team of specially trained callers who pick up the phone and call the appropriate insurance companies for every single patient and provide you with detailed information before you start treatment.


Increase revenue

The number one problem with claim denials - inaccurate benefits information and pre-authorizations is solved. Watch your claims get paid and your reimbursements skyrocket.

Slash costs

It costs less to invest in our specially trained team to handle eligibility calls than to have your internal staff waste time on the phone.

Increase your staff efficiency

Your staff should be spending time on other important tasks to improve patient experience and grow your practice, not sitting on hold with an insurance company.

Reduce stress

You get current information about all patient benefits and can be assured that your claims won’t be denied due to eligibility or pre-authorization issues.

Leave the long calls to us

Whether it takes us 5 minutes or 60, we'll stay on the phone with the payer as long as needed to get you all the information to submit a clean claim and get paid. When you use our eligibility verification and pre-authorization service, you’ll save money, collect more from payers, and grow your practice.

READY? LET'S TALK

The Cost

The cost is $8 per patient with a monthly minimum of 50 verifications / pre-authorizations. If this number is not reached, we will charge the minimum charge for 50 verifications, which is $400 for that month. No carry forward. If you see 5-8 new patients a week, you'll easily reach the monthly minimum because you'll do 5-8 verifications a week, plus additional verifications during re-evaluations / progress notes (highly recommended). You will also need pre-authorizations for many of your patients.

No Contracts

Our pricing model is simple and transparent - no contracts and you can cancel anytime.

The Savings

If you pay a staff member $15/hr, and they spend 45 minutes getting eligibility information, entering this information into your EMR and filling out authorization forms, you've now invested about $10 into the eligibility verification for that patient, and you may still end up with incomplete / inaccurate information, which ends up costing you much more.


We Make the Calls

We call the payer, and stay on hold for as long as it takes to get you the information you need.

We Know What to Ask

We know exactly whom to call, and what to ask. You'll have the information the second we do.

You Stay Current

Payers regularly make policy changes without notifying you, and most patients don’t know their current policy benefits. Leave this to us.

No Fine Print

Month to month. No contracts. Keep us around if you're happy.

Secure, Encrypted Data

We use a 100% secure, encrypted HIPAA protected communication channel to send you all patient data.

Happy Patients

We verify all patient benefits & obtain pre-authorizations, so you can discuss payment options with patients before beginning treatment. 

READY? LET'S TALK