The insurance discovery tool is a unique software created by combined expert Revenue Cycle Healthcare professionals along with state of art Artificial Intelligence. There are 15 algorithms used to discover the current accurate payer for the patient. This helps in extending retrieving capabilities to Medicare, Medicaid, Commercial and private payors. The software has the ability of upgrading the algorithms based on the output retrieved from the payers.
Collection of precise patient demographics and insurance demographics data by the patient access team is vital in a number of ways. The patient access teams responsibilities include however not restricted to appointments and scheduling, Patient Registration, Collecting and preparing a EHR of patient demographic details, Collecting and preparing a EHR of insurance demographic details, Checking for patient insurance eligibility and insurance coverage, Checking the patient’s insurance for benefits covered under the patient’s active insurance plan, Medical record preparation, Collecting and posting the Co-pay from the patient into the PMS tool.
At times there are situations wherein the patient forgets to get the insurance card for registration process, times wherein the patient does not remember the correct insurance ID number, times when the patient is not aware of other active coverage or on the spot instances where-in the billing office staff will require to check active coverage for the patient the Insurance Discovery tool plays a major role in lending a helping hand thereby increasing the efficiency of the patient access team.
By entering a few key patient demographic details, the tool has the retrieval capabilities of the current responsible insurance information. The retrieval of the insurance information plays a vital role in situations where in the patient has not given the insurance details or for cross verifying the insurance demographic details provided by the patient in a click of a button rather than long hold times with the payors also it provides missing or incorrect insurance information provided at the time of registration.
The insurance discovery capabilities are not only restricted in retrieving the coverage details of the patient, in addition it provides the COB (Co-ordination Of Benefits) information. The tool is created to support retrieval of accurate insurance data including from payor plans such as HMO’s and Medical Groups. The COB sequencing of the payors is provided to the CBO.
Identifying the COB information facilitates the CBO in filing the claim to the correct payer by collecting accurate data and reducing the chances of the claim being rejected/ denied for missing patient/ insurance demographic information. The time/ efforts spent here reciprocates in faster re-imbursements and lower AR days.
To conclude the Insurance Discovery software is pivotal tool for the patient access team that simplifies their work increasing the efficiency provides in check and balances to verify the insurance demographic information provided by the patient if they have. Identifying the responsible insurance carrier in-case the insurance demographic is missing/ invalid or incomplete. The Insurance discovery takes a step forward and drills down to identify the COB information of the patient which is an added advantage.
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