Verify Insurance

The number one reason—by far—for denied claims is failure to verify insurance. Common denials associated with not verifying insurance information include:

  1. Subscriber not eligible on date of service
  2. Services not covered or maximum benefits have been met
  3. Services were not authorized or authorization required

Your office should verify a patient’s insurance eligibility on every visit. For example, you might establish parameters in your billing practice that would not allow a claim that requires a per-authorization to be filed without that authorization number. At the very least, a person should call carriers on every patient prior to a procedure, to verify their eligibility and the limits of the patient’s benefits. It does take a little longer in the beginning, but is well worth the extra time spent on the front end. Remember: every time your start over with a claim you are losing money, and are filing inaccurate claims.

Judy Wilson
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About Has 11 Posts

Ms. Wilson has been in the medical coding/billing business for over 35 years. For the past 25 years, she has been the Business Administrator for Anesthesia Specialists, a group of nine cardiac anesthesiologists who practice at Sentara Heart Hospital. She had the honor of serving on the AAPCCA from 2010-2014, and is now serving again from 2015-2017. She is also on the board of directors of Bryant & Stratton College in Virginia Beach, VA. She serves on the National Advisory Board for American Academy of Billers for AMBA. She has spoken at several AAPC regional and national conferences. She has authored several articles, including for HCPRO/Just Coding and AAPC’sHealthcare Business Monthly magazine.

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