Wiki Insurance Verification-How do I make sure info is accurate?

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KrisK

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I am working as a receptionist and am being allowed to call insurance companies to verify coverage for patients prior to their 1st appointment. My challenge is that I am not always receiving correct information. For now I am "re-checking" anything that the Dr is questioning...is there anything else I can be doing to help myself & make sure that the insurance I am receiving is accurate?

Thank you in advance for any suggestions ~ Kris
 
All you can do is verify the number to the patient ID and the ID to the patient. Most payers have online look up for you so you do not need to spend all you time on the phone. However most commercial carriers have what is called a "float". That is if the premiums are not paid on time, the patient is still covered, for 90 days and claims will be paid. However if the premiums are not caught up and paid by the end of the 90 days then coverage is voided and any claims paid within the float time is requested to be refunded. There is nothing that can be done on this. You will never know if the premiums are being paid or not.
 
Unfortunately you will never be able know whether everything you are verifying is totally accurate. The member is also responsible to know their benefits so all you can do is try your best to ask the right questions and if something seems off try to question it with the insurance plan. One thing I will sometimes do is bring up benefits online and as I call to the insurance company try to cross reference some of the info to see if it matches from what the rep or IVR is telling me. As you gain more experience verifying you will start to remember little things about different plans and how they work depending on the benefit you are verifying. Just make sure you are disclaiming to the patient that you are merely quoting coverage that you obtained from the insurance company based on their plan and that you can not guarantee their benefits. Remember even the members own insurance company will not guarentee benefits, there are too many variables of things that can happen for the provider to insure how a certain claim or benefit will be covered (such as michelle mentioned with the "float") . Just do your best, you will be fine!
 
Remember that no matter how diligent you may be, there will be those times when the information you receive (even though accurate) may get "lost in the cracks of communication" whether it be COB, non-payment of premiums, a simple alpha-prefix being missed, etc, etc. Even the most sophisticated and up-to-date tools eligibility tools and the carrier portals aren't always 100% accurate. That's why the front office intake and insurance verifying is such an important task. Do the best you can realizing that re-checking and staying on top of this is critical to the practice's financial health!
 
When I verify insurance benefits for my patients, I always write down the date, time and name of the person I spoke to along with the benefit information. This way if the insurance does not pay correctly or denies because of no prior authorization, I give them the information that I wrote down. Since these insurance companies record all their calls, they can go back and listen to that conversation. If they hear what was quoted to me they have to go by what the customer/provider service rep. told me and pay accordingly.
 
I work in a Blues Plan and can tell you everyone's response is very accurate. We have groups that will retro-term an employee, as well as issues getting accurate COB information. Our state has its own exchange and terms do not arrive timely for us to prevent claims from processing in error. I recently had to respond to one very complex COB case where the physician office was given accurate information at the time of contact, but the retro-terms prevented the claims from processing correctly. Sorry! Sometimes - it's not the payer's fault either.
 
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