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Insurance Eligibility Verification Software

Hospital Lab Outreach, Clinical Labs, Molecular Diagnostics Labs,
Pathology Groups, Physician Practices, and Radiology Services

  • Fast
  • Secure
  • Easy to use
  • Eliminate Errors
  • Reduce Operational Costs
  • Improve Patient Satisfaction
  • Improve Medicare Reimbursments
  • Flexible Patient Payment Solutions
  • Billing Transparency
  • Increase Cashflow
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The Challenge

Verification of patient insurance across different medical specialties and service lines is challenging due to business complexities and unique workflows. Organizations should not be bound to using backend insurance claim scrubbing software to perform insurance eligibility validations in these busy fluid work environments. Physician practices necessitate the upfront bulk checking of the entire day’s scheduled appointments before start of business day or real-time validation during appointment registration.

  • Hospital labs, clinical labs, molecular diagnostics labs, and pathology groups often provide testing to physician offices. The challenge is the insurance eligibility checking occurs in the physician office setting with updates to patient and insurance demographics often occurring after the lab specimen has been collected and picked up by lab courier. Laboratories need to be able to perform automated end-of-day bulk checking for the entire days’ work or on demand if performed at a patient service center.
  • Capture of co-pays, remaining deductibles, verification of patient’s address, look up of test charges, and management of payment plans is a mission critical requirement.
  • 3 to 5 day bill hold prior to claim submission is pretty much standard in the industry, taking advantage of this block of time to perform insurance eligibility checking and work on the failed status accounts is an efficient use of this down time before the claim is released.
  • Ability to look up the Medicare Beneficiary Identifier (MBI) when the social security number is presented for Medicare claims creates efficiencies

The Solutions

  • Patient Verification
  • Insurance Eligibility Checking
  • Patient Financial Experience
  • Unique Functionality

Patient Data Scrubbing

Incorrect patient demographic data is a constant challenge for billing departments. Systematically scrubbing of patient data prior to initiating a “270 insurance eligibility request” to the payer minimizes wasted time and effort tracking down clean information to complete the request. Frequent errors identified and fixed prior to the request include:

Errors Identified
  • First name incorrect
  • Last Name incorrect
  • Personal name suffixes
  • Incorrect D.O.B. or SSN
Additional Benefits
  • Patient Statements
  • Return Mail Checking
  • Customer Service
  • Driver’s License Bar Code Scanning

Seamless Data Integration

  • Automated real time access to 100’s of payers participating in the 270 request / 271 response program
  • Patient Coverage Summary - real time view of remaining deductibles, co-pays, and coordination of benefits
  • Deployed as on-demand or in batch submission to address end of business day for laboratories or scheduled appointments for physician practices or radiology visits
  • Medicare Beneficiary Identifier (MBI) look up
  • Displays the different possible combinations of data elements required by each payer for a successful request ensuring you have met the minimum requirements
  • You can perform a check without having to perform a detailed registration
  • Acts of one source-of-truth that is accessed by front-end registration and back-end billing teams
Additional Benefits
  • Automated Workflow Queues
  • Mouse Click Transfer
  • Statistics Reporting
  • Easy System Integration

Payment System

Includes a robust and full-featured patient payment interface, automated collections and an array of payment options that work for your patients.

Ability to calculate patient responsibility prior to time of service
Accept cash, check or credit card payments
Test price look up for transparency
Real time access to patient’s co-pay & remaining deductible
Setup payment plans at point of service
Medicare Benefit Identification (MBI) Look-Up Tool

Delivering patient Medicare beneficiary IDs for quick Medicare reimbursements

  • Easy and reliable access to accurate 11-digit patient MBI’s will reduce your Medicare rejections and denials.
  • Requires only a first name, last name, zip, or DOB to initialize the search

Automated Transfer of Verified Information into your System

Having the ability to update validated patient and insurance demographics quickly and systematically in your information system keeps the assembly line of claim submission running on time with accuracy.

  • With just a click, move scrubbed and validated patient data into your Order Entry or Billing System.
  • Eliminate manual data keying, and keep errors out of the other downstream systems

Integrate Insurance Eligibility Checking Directly 

Embed insurance eligibility checking software directly into your order entry or billing system as a seamless popup for ease of use, speed, and accuracy eliminating manual data entry

  • Launch the insurance eligibility check within your system to prevent jumping around outside systems
  • Validated eligibility information will automatically populate into your system

Multiple Insurance Discovery

The frustrating experience of receiving orders without insurance or expired insurance is a challenging, time-consuming process to look up other insurance for a validated match.

  • Based on your top insurances, your lab works with serves as the foundation of a search algorithm used to identify the potential insurance company and validate eligibility for patients that have no or expired insurance.
  • One request can quickly perform automated searches for the highest probable insurance companies in your service area with a predefined set limit.
  • This approach is quicker than performing multiple individual attempts

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