Clinical Labs services are spots of Health Care facilities that mostly do not interact with the patient except for the nurses who face the patient for specimen collection. Service providers who write the report/ do the tests on the specimens/ extract specimens etc need to be reimbursed for their services. However, they may not be interacting with the patient directly to collect the required patient demographic and insurance demographic information.
Collection of patient demographic and insurance demographic information plays a vital role in the life cycle of the claim. The clinical labs are mostly backend services and rely on the data from the Healthcare service facilities or third-party data to create the claim for their services. There are multiple setbacks in such a scenario as follows when depending for data from others
- Missing/ incomplete insurance demographic information
- Failure to forward insurance demographic information
- Backlogs or delay in sharing the collected information that can have a ripple effect in filing claims for the clinics/ labs
- The patient could have not provided the insurance information at the time of service
- The patient could have enrolled themselves as self-pay due to un-awareness of insurance coverage and benefits
- The facility could have missed to collect the COB (Co-ordination Of Benefits) information
Even if the patient demographics/ insurance demographic details are available with the clinics or labs, they need to check the coverage and benefits of the patient. This requires considerable manpower, time and effort.
The Insurance Discovery software from eClaimStatus is a user-friendly tool created by a group of industry Healthcare veterans combining years of Healthcare Revenue Cycle Management experience along with Artificial Intelligence to provide a solution in such tight corners. The tool comprises of 15 algorithms that retrieves active insurance coverage of the patient by entering a few key patient demographics. The tool has the capability of updating the algorithms based on the output data retrieved from the payors.
Details from the patient face sheet that comprises of the patient demographic information such as DOB (Date of Birth), full name, current address, SSN etc can be used to identify the active insurance coverage of the patient. All active insurance coverages are listed by the help of the tool. In addition, the Insurance Discovery tool has the capability to identify the COB (Co-ordination Of Benefits) information by sequence. In-case of a HMO plan, the Insurance Discovery tool provides the responsible medical group where the claims are to be submitted. The retrieved data is precise that can be utilized by the CBO (Centralized Billing Office) to create the claim that’s to be sent to the payor for the services rendered by outside labs, lab technicians, specimen collection, tests etc.
The Insurance Discovery tool is a perfect solution in such scenarios where the patient may or may not have contact with the healthcare service provider. The tool improves the efficiency of the staff thereby reducing the need for a lager team to complete the work. The tool has the capability of retrieving insurance details for single patient and batch option for multiple patients.
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
