Insurance Verification and Pre-certification Services

Challenges:

• Insurance verification is one of the most neglected key elements in the revenue cycle process due to the staff’s overwhelming schedules and administrative tasks.

• On average, 40% of healthcare denials are related to the lack of insurance verification or improper insurance verification. This is a common costly negligence that impacts timely reimbursement and your bottom line.

• The lack of insurance verification will result in:

• cash reduction due to claim denials for terminated coverage,

• delayed insurance payments, and

• decreased patient satisfaction due to dealing with the hassle of denied claims and incorrect patient statements.

LEGACY CONSULTING offers the following services:

• Obtain schedule or list of new patients from the client in advance of the patient’s scheduled appointment and verify coverage on all primary and secondary payers using websites, Automated Voice Response and phone calls to the payers as necessary.

• This will reduce the administrative costs and burden from you and staff to allow them to focus on patient care.

• The verification service includes:

• Effective and term dates of coverage

• Co-pays

• Co-insurance

• Deductibles

• Type of plan and coverage details

• Payable benefits

• Patient policy status

• Type of plan and coverage details

• Plan exclusions

• Referrals and pre-authorizations

• Benefit maximums

• Provide timely results within 24 hours.

• This will also reduce administrative costs to you and provide your staff with the knowledge that they need to

properly file a clean claim to the payer and collect co-pays and patient out of pocket expenses up front at the

time of service.

• Obtain pre-authorization numbers and/or pre-certification numbers as required from the patient’s plan.

• This will ensure timely payment for services rendered that require prior approval from the payer.

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