The hospital/ facility is a hub for healthcare service where large number of patients seek medical services in various specialities at different time of the day. The facility may vary in size, specialities, services offered for treatments as per each individual organization, which can have a direct proportion to the staff and providers servicing at the facility. The facility can cater to individual specialities that they may specialize or could be a multi-speciality that cover a wider range of bifurcation of the patients who may visit them for based on the requirements.
The service provider location can be further classified into
- Facilitates that can have direct contact with the patient such as doctors visit, operation, vaccinations etc
- Facilities that do not have direct contact with the patient such as labs, x-ray, scan facilities etc
However, the healthcare provider needs to be reimbursed for the rendered medical services.
The Insurance Discovery software, a tool designed by veterans with vast healthcare knowledge combined with state of art Artificial Intelligence algorithms that can update as per the output from the insurance payors. The tool retrieves active insurance coverage for the patient by entering a few demographic details.
In a hospital/ facility scenario wherein the volume of patients is high it becomes very difficult to perform eligibility/ benefits check at the time of registration due to the long phone hold times with the insurance companies. Deploying a large team to verify eligibility/ benefits/ coverage information is practically impossible due to man power costs and workspace environment. The Insurance Discovery solution provides a solution by retrieving information for individual patients as well us batch patients for multiple patient’s data retrieval.
If the patient does not remember the insurance coverage details or fails to get the insurance card details during the visit to the healthcare service facility or hospital they can provide their demographic information and the patient access team can retrieve their insurance information. The tool can additionally retrieve COB (Co-ordination Of Benefits) that can help the CBO (Centralized Billing Office) to file the claims to the responsible payor. The patient may not even be aware of all the coverage benefits through spouse or employer therefore may not have provided the details at the time of registration.
During emergency situations the patient may not be in a state to provide the insurance details to the attending physician/ nurse or the patient access team. In such cases the patient may be registered as self-pay patient. The higher the self-pay portion in the outstanding financial report indicate a poor management of Account Receivables. The reimbursements in such scenarios may take a longer time to be collected from the patient. The filing of claims to the payor may be delayed until the patient is able to provide insurance demographic details if they have.
Collection of key patient demographic and insurance demographic reaps benefits post billing of the claim by avoiding claim rejections and demographic related denials. A unique tool such as Insurance Discovery benefits the patient access team by easing their work, improving efficiency and focus on their primary objective which is to provide Healthcare services for the patient.
Leave your insurance eligibility verification to eClaimStatus. Get started with your 15-day free trial, call us at 310-294-9242 or write to us sales@eclaimstatus.com
