How Automated Insurance Verification Reduces Manual Work

How Automated Insurance Verification Reduces Manual Work

Insurance verification is a critical process for healthcare providers to ensure patients have active insurance coverage. Traditionally, it has been a manual process requiring staff to call payers or use web portals to check patient eligibility and benefits. However, such approach can be extremely time-consuming and prone to human error.

In recent years, various software solutions have emerged to streamline the verification workflow. This article examines the key benefits of using automated insurance verification, including accuracy, efficiency, costs, and implementation challenges.

Error Reduction

One of the biggest frustrations with manual verification is accuracy issues. When staff have to look up coverage details across multiple payer portals to check data, data entry errors can occur. Important information may even be misinterpreted or overlooked completely.

By eliminating manual lookups and data entry, automated systems reduce the risk of human error substantially. According to the CAQH 2022 Index, over the past ten years, there has been a 25% increase in the automation of eligibility and benefits verification. This can be attributed to providers using medical insurance eligibility verification software to obtain the up-to-date data.

Coverage Changes Tracking

Higher accuracy translates into fewer claim denials and less staff time spent resolving errors through phone calls and appeal letters. Additional automated coverage changes tracking feature ensures verification is performed consistently for every patient.

Automatic notifications are sent to alert relevant parties of any alterations in insurance coverage, reducing the risk of overlooking crucial updates and subsequent claim denials.

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Improved Efficiency and Cost Savings

Manual verification takes significant staff time and resources which could be better utilized for revenue-generating tasks. Employees often use multiple portals to check eligibility, benefits, deductibles, co-pays, and effective dates across different payers and plans. Just a single eligibility request can take only a few minutes per patient.

Alternatively, automated verification uses electronic connections to validate all coverage details in seconds once integrated.

Recommended Reading: Medical Claim Forms in Healthcare

Real-Time Verification

Rather than having to check periodically before visits, verification can be performed on-demand at patient check-in to guarantee up-to-date coverage information.

Real-time access is critical to prevent issues like lapsed policies or changed details that staff may miss. Automated software can even integrate eligibility data directly into practice management and EHR systems once available. This prevents any lag between verification and when providers need the details during treatment or billing.

Customizable Automation Workflows

While automated platforms offer vast improvements, medical facilities have unique needs and workflows. The best insurance verification software solutions provide flexible tools to automate processes tailored to each provider’s needs.

Flexible automation guarantees a consistent verification process, while permitting staff oversight when necessary.

Overcoming Implementation Challenges

Transitioning from manual to automated verification requires upfront work, like installing new software.

The employees will need to get used to the new automated approach. It takes time to trust the technology and change the manual verification habits.

Overcoming Implementation Challenges

The software and setup fees seem minimal compared to payer connection charges, which often have multi-year contracts. These costs may sometimes cause hesitation, but the managers must analyze productivity and accuracy gains to realize the long-term value of using automated software.

Key Takeaways: What You Really Need

When evaluating automated insurance verification tools, medical practices need to determine must-have capabilities vs. nice-to-have features. Fundamentally, your verification process must have:

  • Real-time capabilities to enable on-demand, up-to-date verification
  • Automated coverage changes tracking with regular notifications
  • Customizable workflows to meet unique practice needs
  • EHR integration capabilities

Once integrated, automated verification quickly proves its worth through boosted productivity, lower denial rates, and better financial performance.

When assessing solutions, focus less on specific software bells and whistles, like coverage tracking.  Strong customer support is also critical during the transition period. While upfront costs can seem daunting, carefully analyze the ROI based on your patient volumes, resources spent on verification today, and denial rates to justify the investment.

Recommended Reading: Medical Claims Management for Healthcare Providers & Hospitals

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