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How Can Insurance Verification Specialists Help Healthcare Providers Operate Efficiently

  • August 3, 2023
  • 8 min read
  • By Sabeeha Banu

Claim denials can be complex and frustrating. They are the most prevalent barriers to effective revenue cycle management. In addition to taking extra time and resources to process the claim, it slows down the cash flow. Poor insurance claims experiences may also lead to a $170 billion threat to global insurance premiums by 2027.

While Insurance Eligibility Verification is a vital process, it is also considered a tedious task. Therefore, it is ideal to hire an insurance verification specialist. 

Insurance Claims and Underwriting

Next in Insurance: Top Insurance Industry Trends in 2023

Massive hurdles over the past few years have compelled insurance carriers as a whole to become more adaptable, and technology-focused. Insurance companies must continue to discover ways to innovate cost-effectively, given the impending global recession and ongoing geopolitical unpredictability.

The Adoption of AI

Insurance claims

Artificial intelligence (AI) is impacting one of the most significant changes in the insurance industry as a technology driver. The insurance sector will experience a substantial shift from "pay for damage" to "prevent damage" as biosensors, intelligent gadgets, and deep-learning algorithms are integrated into products.

The proliferation of IoT and AI in the general population will render the current method of processing claims outdated and pave the way for automated claim processing. Therefore, businesses must develop plans and stay current on industry trends in the insurance sector.

Digital Convenience

91% of today's insurance customers are willing to use online buying platforms and demand digital convenience from their insurance companies.

As a result, carriers and agencies should focus on enhancing how digitally friendly the customer purchasing process is. One strategy is to improve the application and intake experience across numerous scenarios and channels. 

Consumers are embracing insurance technology trends as they become more tech-savvy to make purchases, manage policies, make payments, file claims, etc. Giving customers more power and control would enhance their experience. However, businesses would also gain from this change by reducing the cost of customer acquisition, increasing insurance agent productivity, increasing customer retention, speeding up claims processing, and securing brand value and position. 

Streamlining Mobile Applications

Presenting tailored premiums is quicker with mobile apps' improved access to consumer location and essential data. Carriers that adopt mobile apps for policyholder acquisition, maintenance, and retention become long-term, crucial partners by raising the value they provide to customers. 

Today insurance companies should focus on robust features, an appealing user interface, and highly customized experiences. Prospective customers want recommendations automatically filled in and quick access to human connection. So businesses need to integrate telemetry tools and provide simplified claims processing to encourage policyholder engagement.

Focusing on ESG

Environmental, social, and governance (ESG) efforts continue to be a strategic and compliance focus for insurers, giving both a considerable challenge and a chance to have a positive influence. 

According to Capgemini's study, 85% of global insurers anticipate that ESG will have an impact on every aspect of their operations, with investments leading the way (91%), closely followed by risk and internal audit (90%) and underwriting (88%).

For insurers, implementing strategic ESG practices has several benefits, such as enhanced reputation, potential loss reduction, and contribution to a more eco-friendly environment.

Embracing Blockchain Technology

Cyberattacks on multinational corporations significantly rose during the pandemic by 81%. For tech-savvy scammers, it is simple to target the insurance industry. To this end, blockchain technology can help in fraud detection and risk reduction. Operations will be secure and efficient, resulting in openness between insurers and reinsurers, with smart contracts for insurance policies and the encryption of medical records.

Businesses of any size should incorporate Blockchain into their core business processes and stay up with technology improvements in the insurance industry. They should get familiar with the deployment of blockchain technology as it affects the insurance sector.

What Does an Insurance Verification Specialist do?

Also Read: Prepare for Emerging Challenges in 2023 (and beyond) with a Virtual Insurance Assistant

An insurance verification expert confirms a patient's insurance details and their eligibility to get medical care. They look at the patient's insurance papers to determine their coverage and limitations before escalating any problems to the supervisor for quick resolution. 

Insurance Verification specialist Responsibilities

An insurance verification specialist job may require post-secondary training with a high school degree. Certification may be advantageous even though it's not required. They must have prior experience in customer service or a related field.

Why Is Insurance Eligibility Verification Important?

Medical practitioners can estimate the patient's financial liability by verifying insurance coverage before the required surgeries. Verifying insurance coverage ensures payment for the services provided by medical providers. 

Insurance eligibility verification enables healthcare professionals to assist their patients in gathering all the information they require in advance. In the same way, confirming insurance eligibility beforehand safeguards healthcare professionals from circumstances in which insurance has expired. 

Insurance Verification Checklist:

Insurance eligibility verification will need to validate many specifics, including:

  • Patient’s name
  • Date of birth
  • Address
  • Social Security number
  • Insurance carrier’s name
  • ID number
  • Type of plan
  • Coverage details
  • Policy status
  • Effective date
  • Payable benefits
  • Plan exclusions
  • Co-insurance, co-pays & deductibles
  • Pre-authorizations & referrals
  • Health insurance caps
  • Type of Medicare coverage
  • DME coverage
  • And more

What Does the Insurance Eligibility Verification Process Look Like?

All insurance eligibility verification solutions adhere to a set procedure to ensure that insurance coverage is in place. The following steps make up the process:

Insurance Verification Checklist

When verifying insurance, ask the correct questions. Staff at the front desk should input data obtained from the insurance card, phone calls with the insurance provider, or computerized eligibility systems. Each patient's electronic medical record should have the following information to verify insurance eligibility:

Collect a Copy of the Patient's Insurance Card

Gather data for the insurance eligibility verification by requesting a copy of the patient's most recent insurance information. If the insurance information was input incorrectly, your electronic health record has an updated photo of the insurance card on both sides. Before submitting claims, medical billers should verify that ID numbers match cards.

Contact the Insurance Provider

Contact the insurance company directly to verify eligibility. Call the provider hotline or use your connected EMR and billing system to ping significant payers like Medicaid, Medicare, or Blue Cross for eligibility details. 

Insurance Assistant

Record Information

Be extra careful while putting patient information into the patient record. Because the data serves as the foundation for the medical claim, a single missed figure can mean the difference between a clean claim and a denial. Rushing through insurance verification processes and entering incorrect data may cause payment delays of several days or weeks or even a complete claim denial.

Follow Up

Follow up with the patient regarding insurance details if there are any queries or worries. Use a patient portal for email or online contact to tell patients of eligibility, or office personnel can also call the patient to inform them of copays or other concerns. 

Update Billing Software

Update the details on insurance coverage, pre-authorizations, and particular patient information to issue medical invoices.

5 Key Reasons to Hire Virtual Insurance Verification Specialist

There has been a noticeable increase in the insurance verification process in recent years. It is essentially a result of the elevated priority given to streamlining administrative procedures, enhancing cash flow, and lowering claim denial rates. 

Insurance Eligibility Verification
Source: Benzinga

The above market research analysis for 2023 to 2030 depicts the present situation and potential growth of the "Insurance Eligibility Verification Market".

According to projections, the worldwide Insurance Eligibility Verification market will surpass $1 billion by 2030, growing at an astonishing CAGR between 2023 and 2030.

Insurance verification is necessary to guarantee that the services rendered are paid. Inaccurate insurance eligibility verification may result in claim denials, holdups in reimbursement, and delays in the patient's visit. Here are the top five reasons to hire virtual insurance verification specialists:

Streamlining the Verification Process to Save Time and Effort:

Outsourcing Insurance Eligibility Verification to a skilled team with a streamlined workflow to handle every verification, from calling the insurance company to documenting the most recent revisions to the insurance policies, can speed up the processing of your claims. It will cut down on unnecessary delays.

Reduce Claims Denials and Waiting Time:

An outsourcing company is adept at submitting more accurate claims. They are specialists at identifying false information, which reduces the need for claims rework. A skilled virtual insurance verification specialist keeps up with changes to regulatory policies, figures out previous authorization requirements, files better claims, increases income flow and follows up with the insurance company regarding authorization issues. 

Enhance Patient Satisfaction and Reimbursement:

Virtual insurance verification specialists have access to updated insurance eligibility information. They can advise the patient whether or not they are eligible for insurance coverage. Furthermore, they increase the possibility that claims will be approved, handled quickly, and paid out on time.

Address Security Concerns

Hospitals save a vast amount of patient information on their portal. These details are open to hackers who might use them for financial gain. Keeping sensitive personal information in medical records secure is thus mandated by law and morality. For this, it's critical to address cybersecurity issues and stay current with technical advancements for data protection. You can get the best safety guidelines from a reliable virtual insurance verification specialist supplier with specialized tools.

Cost-Effective Solution:

An outsourcing firm offers the highest caliber insurance eligibility service at a reasonable rate. A medical billing company that outsources has the cutting-edge infrastructure and dependable staff to process your claims swiftly and correctly at a reasonable cost.

End Points

Insurance Specialist

Virtual insurance verification specialists offer a ton of benefits. For this, medical professionals need to hire skilled insurance verification specialists, which can be time-consuming and tiring. To this end, Office Beacon can help. Office Beacon is a pioneer in providing skilled insurance verification specialists to avoid the risks connected with denials, inaccurate insurance eligibility, and benefits. For 23 years, Office Beacon has provided perfect end-to-end medical claims processing services.

Written by Sabeeha Banu

Sabeeha is an avid reader, writer, and poet with experience writing in various genres. She is adept at delivering write-ups that drive engagement. In her free time, you can find her soaking in the mesmerizing beauty of nature and weaving her thoughts.

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