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Checking a patient’s eligibility

 In Blog

Photo by Mikhail Nilov from Pexels

A fundamental aspect of a successful community clinic’s management is to check with insurance carriers the eligibility and benefits of the patients. Knowing this information beforehand is key to have your appointments running smoothly, avoid delays in payment, and boost revenue at the time of service. It also prevents unpleasant surprises, which increases patient’s satisfaction.

Before a patient arrives, it’s important to know what kind of insurance they have, if said insurance is active, and if they are assigned to your clinic, to ensure that you’ll receive payment for the services rendered. Once you know the type of insurance the patient has, and you have the member/subscriber ID, you need the following information:

– Name
– Last name
– Date of birth
– Doctor’s name of the clinic they’re assigned to

If they say a doctor’s and clinic’s name that’s not your clinic, you must advise the caller to request a PCP change to your clinic to avoid any issue. If they state that they’re assigned to your clinic, proceed to verify their eligibility in the corresponding website. Once this process is done, we can move forward to the patient’s needs.

On some occasions, the patient won’t have their insurance information in hand. If this is the case, there are websites where you can check their eligibility with a SSN and date of birth, or with their initials and date of birth. There are other cases where the insurance might be inactive, so advise the patient to call their company to resolve this. If you are trained to help them out, do so in the same call.

Verifying a patient’s insurance eligibility can feel overwhelming, so we’ve compiled this quick and easy guide for you:

– Collect patient’s information (Name, DOB, Member ID).
– Verify what type of insurance the patient has.
– Go to the insurance website that the patient has and paste the member ID/subscriber ID. Introduce the DOB of the patient and the info needed. (This varies depending on which website you are using to check the eligibility.)
– Click on Submit.
– Then, verify if the patient is assigned to the clinic by checking Clinic Name, Insurance, Doctor Name and Phone Number. Make sure the insurance is active.
You could also check additional information such as coverage, beneficiaries, effective day and some others.

Nomad Desk offers community clinic’s call center solutions that might be right for you. From checking a patient’s eligibility to taking care of your office after-hours, we deliver results: 79% less waiting time, and 100% answered calls. Give us a call or send us a message if you want to know more about how we can help your clinic.

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