Is Using Electronic Real-Time Health Insurance Eligibility Verification Software Enough?

We get this question a lot here at One Body. Can your clinic just use your EMR’s real time eligibility software solution to verify patient health insurance benefits? It’s easy and quick, but is it enough to ensure that you get paid what you are owed by insurance?

The short answer is, it depends on your level of risk tolerance. Do you have a high risk tolerance? If yes, then just relying on electronic health insurance eligibility tools might be okay. Unfortunately, these tools pull directly from Availity or other portals and only contain as much information as the portal wants to display. The portals get information directly from the insurance companies via EDI connections which contain any information the insurance company wants to share with the portals. So the information you are relying on is only what the portals and insurance companies choose to display. By not calling payers to confirm all the information you need before seeing the patient (if you are curious to know what you should be asking you can find that here), you are taking on the risks that (1) the information on the portals is incorrect, (2) the information on the portals lacks key information you should know before seeing the patient and (3) you may misinterpret the information and your claim may get subsequently denied. 

An alternative to relying solely on electronic verification of benefits software is to use One Body. One Body calls payers for you and provides you with a comprehensive verification of health benefits report so you can ensure you get all the details you need confirmed by the payer before seeing the patient. If you are interested in learning more, fill out the form below!