Electronic Patient Eligibility

The Problem with Electronic Patient Eligibility Solutions and How to overcome them.

Most practices have some sort of protocol for checking patient eligibility prior to appointments. While some still rely on manually checking patient eligibility via calling the insurance providers, few private practices can spare the man hours it take to verify coverage in this manner. For those who do maintain patient payment information in-house, there are a number of options. Most different modes of checking patient eligibility have their own benefits, as well as problems to overcome.

Options for Checking Eligibility

While manual verification is an option, and might be necessary in some cases even using electronic patient eligibility solutions, the following list will focus only on electronic options.

1.Integrated Solutions

Integrated patient eligibility solutions are compatible with and work through your patient management system. This is possibly the most effective way to check patient eligibility in-office. The positive side to this option is that the staff is already trained on the management system, so it’s only another facet of software they’re familiar with rather than an entirely new interface. This method also offers the option of verifying multiple patients at one time, rather than checking each individual patient separately, so it can streamline the workflow for staff members in charge of verifying eligibility. On the negative side, not every patient management service offers this option. If your practice already uses a patient management system which doesn’t offer this, it would be necessary to upgrade the entire system in order to switch to this option. There may also be providers not included in the management database, which would mean manually checking eligibility in those cases.

2. Web-enabled Clearinghouse

This option works much like the integrated solution but the interface is on a web portal and not integrated with the practice’s current system. This system allows practices to log in and verify multiple patient’s eligibility at one time. However, some clearinghouses don’t have all services in their database so some patients will still need to be manually verified.

3. Carrier Portals

Most insurance carriers have web portals where eligibility can be checked. This streamlines the time it would take to manually call the insurance company. The downside to this mode of checking is that each portal is different and will need different types of information. Practices must also check each patient separately this way, and will need to log into different websites to check on patients with different carriers rather than the convenience of using one uniform system.

Addressing Issues or Outsourcing 

Outsourcing can be a viable option for many practices because it takes all of the responsibility for checking patient eligibility and securing payments and delegates those tasks to a vendor that does those things exceptionally well. Often, hiring an expert can cut down the time between payments as well as claim denials caused by human error.

For those who do choose to use electronic eligibility systems, the key to cutting down human error and streamlining the process is in training staff to adequately use the system chosen. For those who use carrier portals, having a handy list of the information necessary for each commonly used carrier can be a time-saver for anyone new to the task. For those using a clearinghouse, noting which carriers are not listed in the database as these cases come up can save time on future visits because staff will know in advance that those patients need to be manually checked. The key to overcoming all of these issues is in thinking ahead and proper organization of information.

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