The number one reason—by far—for denied claims is failure to verify insurance. Common denials associated with not verifying insurance information include:
- Subscriber not eligible on date of service
- Services not covered or maximum benefits have been met
- 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.