Insurance Verifications
Sometimes insurance verifications seem more daunting than beneficial. They can be time consuming and tedious especially when you’re familiar with the policy already. However, insurance verifications are important for setting the groundwork for disputes and appeals. Having a verification at the beginning of care helps to accurately anticipate coverage and financial responsibility of the patient. Verifying benefits right the first time will also save you time if your claims fall victim to bogus denials.
A good verification will come directly from the insurance company. Either a digital verification directly through the insurance’s database or a phone call with a provider representative will have enough credibility to support the content of the verification and ultimately any dispute or appeal.
Beware that digital verifications through your practice management software are not as credible to insurance companies as digital verifications through their own databases, even though the information comes from the same place. Insurances do not accept verifications easily from anywhere besides their own databases and phone logs, which is most likely because data can be inadvertently manipulated by technology and possibly misconstrued (think of the game Telephone). With direct verifications, there is a direct chain of custody regarding benefit information from insurance to provider. It’s great to have quick verifications done with a click of a button through your practice management software, but for appeals and disputes you’ll need a verification that comes directly through the insurance company on their own database or by phone with a provider representative.
Either type of verification must have the verification date, a reference number and the provider representative’s name for phone calls. For any digital verifications, print or save a PDF of the verification.
If you’re taking all of these verification steps already but are still getting denials for:
Coordination of Benefits (COB)
No active coverage
Policy effective and term dates
Not a known member
Benefits maxed is a surprise to you (check when they re-set on calendar year or other date)
Visit limit discrepancy
Patient financial responsibility discrepancy
Authorization and referrals,
then you need a solid defense by using an effective insurance verification form to help you win your dispute or appeal. Please check out my insurance verification forms if your office does not have a form that can defend claims that are incorrectly denied due to benefit info. I’ve designed 2 forms: for offices that only provides adjustments and for offices that also provides therapies, acupuncture and massage.
As always, once you review the verification to make sure you understand the benefits, then identify exactly where the discrepancy is between the verification and how the claim(s) processed. Call to dispute or fax/mail an appeal, getting a new reference number each time. Don’t hang up until you’ve gotten the provider representative to re-process the claim correctly for payment. Follow up in a timely manner, and be aware that the insurance company could quite possibly process the claim wrong again (shocking, I know), which would require you to repeat the process. Being diligent will pay off, but I’ll writer more about this process in another article for you.
As a reminder, all of my forms, worksheets and tutorials are emailed to you in digital format so you only pay once and can print unlimited copies for your practice (A LOT cheaper than the pre-printed kind).
Please let me know if you need any help with denials.
Remember, consistency builds momentum, and momentum builds your practice.