6 Common MISTAKES When Verifying Patients’ Health Benefits

Eligibility mistakes are the number one cause of claim denials. The good news is that most eligibility mistakes are preventable!

Below are the most common mistakes to avoid when verifying eligibility.

1) Incomplete information from patients

Make sure you are collecting all the key information from patients – name, date of birth, subscriber ID, group ID, if they have a secondary policy and the insurance phone number on the back of their insurance card. Having incomplete information can lead to issues down the road.

2) Relying solely on online portals

Availity and other insurance portals are great if you just want to know if a policy is active and some other basic information. Apart from that, we all know how unreliable they are. Sometimes they even contain inaccurate information! Most of the time they only include 40% of the information you need to check before seeing a patient. Is authorization needed? Availity usually says “Unknown.” How many visits were used? Availity doesn’t tell you. If you rely solely on Availity you are likely experiencing a lot of claim denials.

3) Relying solely on electronic verification of benefits tool in your EMR

Unfortunately, even though the EMRs include an EVOB product offering and say that it is more accurate than Availity, it’s not. See below for some anonymous comments regarding WebPT’s EMR by some WebPT clients.

4) Incomplete information about your practice

Many practices don’t know if they are in network or not and under which NPI they are credentialed under. This is important information! If you don’t know, you must contact your biller or whomever did your credentialing and review the documents you signed with the insurance company. Do not rely on insurance reps to tell you if you are in or out of network. Many times they will say “I don’t know, ask the provider” or will tell you the wrong information. It’s very important to understand your network status and know which NPI is credentialed.

5) No process or method around verifying benefits

You should know all the questions you want answered by the insurance rep ahead of time and especially before calling. You should also always repeat everything the rep tells you at the end of the call to get confirmation from them that you understand the benefits they told you correctly. This is also helpful in case you need to appeal a claim denial.

6) Thinking verification of benefits doesn’t matter

Verification of benefits is one of the most important things a practice can do to make sure they get reimbursed from insurance! Unfortunately many practices don’t treat it as such and think its something to give anyone who works at the clinic who has time. Verifying patients is time consuming, tedious and requires an immense attention to detail. We all know too well that mistakes are expensive and can cost you thousands of dollars per claim. It’s time to invest in your verification of benefits process.

Hire One Body, the experts in verifications, to help! To learn more, contact hello@onebodywellness.com or fill out the contact form below.