Fast and Reliable Verification of Benefits Services at SHMEDEX

Ensure coverage before services are rendered to maximize reimbursements and minimize claim denials

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Fast and Reliable Verification of Benefits Services

Eligibility and Verification of benefits is the process of verifying the policy details, which include co-pay, deductible, member ID, and benefits information for the patient. At SHMEDEX, our verification service is simple to allow checking insurance coverage, plan benefits, and patient payment information.

The process can ease the claim denials and allow saving time and facilitating a hassle-free payment cycle. Our verification service assists doctors and clinics in verifying the insurance of the patient before delivering treatment. This prevents rejection of claims and improves cash flow.

We do a real-time check with all leading insurance companies on insurance information, and give precise information on:

  • The activation of the insurance for the patient
  • Copay, deductible, and coinsurance amounts
  • Important pre-authorization requirements
  • Beginning and expiry dates of the cover
Patient Eligibility Verification Process

Our Comprehensive Verification of Benefits Process

We follow a detailed 8-step process to ensure accurate insurance verification

1

Collect Patient Information

We get valid information about the patients, which consists of their name (first and last), date of birth, insurance ID, and name of the provider. Our team makes sure that this information is comprehensive and accurate to prevent possible mistakes.

2

Contact Insurance Provider

We make contact with the insurance of patient online or over the phone. We plan to confirm the coverage information, such as the plan type, active status, co-payments, deductibles, and any limitations of coverage.

3

Verify Plan Coverage

We thoroughly check the services that are covered on the insurance plan of the patient. The members of our team verify the eligibility of special treatments, limitations of frequency of treatment, pre-authorization, and out-of-network providers.

4

Confirm Patient Responsibility

We calculate the patient's anticipated financial liability, including co-pays, coinsurance, deductibles, etc. Our process assists in providing the patients with a good idea of what it will cost them before they undergo treatment.

5

Document and Update Records

All our verified insurances are noted and updated in our system. Our accurate record-keeping will allow us to report our claims cleanly and efficiently, minimizing delays and maximizing reimbursements.

6

Follow Up on Missing Information

We provide active follow-ups to the patient or insurance firm where any information is missing or vague. Our team makes sure that all the required information is accessed in time.

7

Verification Summary

We provide our suppliers with an elaborate outline breakdown of the vetted insurance benefits. It enables making responsible decisions regarding patient care and presenting any financial liability to the patient in advance.

8

Re-verify for Recurring Visits

The insurance information is re-verified on patients returning to do further treatment. Our team also makes sure that the coverage is current and in effect at each visit.

Manage Claims with Medical Insurance Eligibility Verification

One of the most important processes in the revenue cycle management process is patient eligibility verification. It makes sure that the healthcare providers verify the insurance coverage of the patient, the plans, and the co-payments before they give out any services.

Pre-verifying eligibility can also allow the practice to tell the patients how much money they have to spend, making the process more transparent and, consequently, more satisfactory to patients.

Moreover, real-time eligibility verification can simplify the medical billing cycle because it avoids the delays such delays or rework-related claims may cause. The ones that ensure the verification of insurance details in advance are better off in terms of cash flow and do not face major difficulties with the cycle of payments.

It also enables the providers to make informed choices concerning coverage limits and patient care. In the long term, this leads to increased rates of reimbursement, lowered administrative impediments, and an improved overall billing process.

Why Choose Our Verification of Benefits Services

Ensure accuracy, speed, and transparency before services are rendered

Accurate Coverage Information

We confirm active insurance policies, plan benefits, copays, deductibles, and limitations on the policy. Our team ensures providers are given the most accurate available data to reduce confusion.

Faster Claims Processing

We ensure that the reimbursement cycle is fast because we check all the insurance information beforehand. Our verification minimizes inaccuracies and time wastage.

Reduced Claim Denials

We minimize claim rejections by pre-determining problems such as dormant policies, authorization requirements, and exclusion requirements prior to service delivery.

Improved Cash Flow

Our confirmation promptly eliminates denials and accelerates payment cycles. We assist in making providers get paid quicker, which prevents gaps in cash flow.

Real-Time Eligibility Checks

We run in-time eligibility programs through which we check insurance status in real time. Our system is interfaced to all major payers for instant access to patient coverage.

Supports Better Decision-Making

We provide comprehensive benefit reports, allowing your staff to make informed clinical and administrative decisions about treatment and insurance choices.

Prevents Costly Billing Errors

Our insurance checks confirm that proper codes are utilized and services are covered. We avoid charges of uncovered services and minimize rejections.

Streamlines Patient Onboarding

We ease our onboarding procedures by vetting enrollment before the admission of the patient. Our procedure minimizes illegal delays at the front desk.

Ready to Verify Benefits the Right Way?

Reach out to SHMEDEX for efficient and accurate Verification of Benefits services. We assist the healthcare providers in verifying insurance coverage (level being covered), copay, deductible, plan limitation, and authorization of a patient to finalize the service being provided.

Start Verification Today

Verification of Benefits FAQs

Answers to common questions about our benefit verification services

Our VOB reports include eligibility status, plan details, covered services, copays, coinsurance, deductibles, out-of-pocket maximums, prior authorization requirements, and plan limitations.

We typically complete VOB within 24 hours. For urgent cases, we offer same-day verification. Our team uses a combination of direct payer contact and automated tools to ensure speed and accuracy.

Yes, we verify benefits for all types of services including medical, mental health, substance use treatment, and specialty care. Our team is trained in payer-specific requirements across various disciplines.

We cross-verify benefit details using payer portals, direct calls, and documented confirmation from insurance representatives. All VOBs are reviewed by a specialist before being delivered to your team.
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