How The Health Insurance Verification Process Works

One thing that no medical professional likes to deal with is insurance. Insurance is a hassle, it’s not always easy to comply with, and they have so many different requirements. What’s worse is that it can seem quite mysterious to those who don’t go through the process day after day.

We’re here to tell you how the health insurance verification process works, what goes into it, and what makes it operate.

What Is The Health Insurance Verification Process?

The health insurance verification process is a series of steps that checks whether or not the patient admitted has the ability to make a reimbursable claim to their health insurance provider. The process is complicated and goes through many different people at both the healthcare provider and the insurance provider.

 

Steps In The Health Insurance Verification Process

Patient Scheduling

The patient makes an appointment with the doctor and the doctor schedules the patient in. The registration can be done through self-scheduling to make the process quick and streamlined. New patients are entered into the healthcare provider’s database. In case of emergencies, the registration may be performed at the hospital where intake happens.

 

Patient Enrollment

The patient’s demographic data and medical history are recorded or referenced by the healthcare provider. This is to identify the patient accurately and make sure that insurance has the right patient.

 

Eligibility and Verification

This is generally the ugly part. Insurance claim details are then cross-referenced by the healthcare provider to make sure that the patient is, in fact, eligible to make a claim. Since insurance fraud is common, this is a necessary step that healthcare providers have to do. This is where health insurance verification services come in. These services can help save a great deal of time.

Authorization

Insurance verification establishes the eligibility of a patient’s insurance claim, but not the requirement of the insurance provider to actually reimburse the patient. The authorization process binds the insurance payer to authorize the claim through a legally binding promise to pay a specified amount. This step should be given careful scrutiny as to prevent denied claims, which can cause a great deal of stress for both the healthcare provider and the patient.

Updating Patient

If there are any changes to the claim, the healthcare provider must notify the patient of said changes. This process is important as patients should not end up with a surprise bill at the end of the whole ordeal.

Updating Medical Billing System

Healthcare providers must update the billing system to make sure that correct charges were recorded. Otherwise, this can have a drastic effect on the organization’s accounting.

Claims transmission

At last, the claim submission request is sent to the insurance provider. This is the final step in the health insurance verification process.