Streamlining Eligibility Verification

The Affordable Care Act has significantly impacted the healthcare landscape in two major ways. The Individual Mandate requires that all Americans obtain insurance coverage, and Meaningful Use requires health care providers to achieve benchmarks in their application of electronic health records (EHR) to streamline data capture and improve patient outcomes. The ACA also expanded Medicaid eligibility to include more lower-income people and extended Healthcare Marketplace coverage for persons who don’t qualify for Medicaid by providing subsidies to them.

Eligibility verification in the new healthcare landscape

With the implementation of these mandates, greater numbers of patients will qualify for Medicaid and more patients will have health insurance obtained through the Marketplace. And the new rules encourage patients with disabilities, low-income patients, and the elderly to find the benefits package that best suits their needs. This means that patients will be switching insurance providers more often than they have in the past.

Currently, health care providers are only able to keep track of their patients’ insurance providers and know whom to bill by making state eligibility requests and waiting for a response. Additionally, not all providers are able to query the State Medicaid website directly – especially if they are subcontractors to managed care organizations. This can result in delays to billing and payment, management headaches, and potential interruptions of care.

Streamlining eligibility verification

Practice Sense allows health care providers to automatically connect to over 200 third-party payers, which means they can verify patient eligibility in real time. This has multiple benefits to patient outcomes. By connecting to third-party payers, health care providers can:

  • Implement faster and more efficient check in times
  • Verify insurance before the patient arrives for their appointment
  • Stay on top of updates and changes to patients’ coverage
  • Reduce billing and payment delays
  • Facilitate an improved patient experience

Practice Sense allows you to verify patient insurance before they are in-office, freeing up valuable time and allowing medical assistants to provide a higher standard of care at reception. Patients can fill out our electronic submission forms online, and will be more likely to submit insurance information that is accurate and up to date. You’ll be alerted to any restrictions to the patient’s network or lapsed coverage before the patient ever comes in for their appointment, which will save you headaches and delays. And you can re-verify patient coverage at any time with the simple click of a button.

Our team is constantly adding new insurance providers to stay one step ahead of the changing healthcare landscape and provide you with the best tools to check eligibility. Contact us today to learn how we can help you.


Topics: Reducing Office Stress, Medical Advancements

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