Why eligibility verification is the first step in the revenue cycle
Failure to validate eligibility and authorization leads to delayed payments and denials. Here is what a thorough verification should confirm.
Delaying reimbursements has a direct influence on cash flow. Eligibility verification protects the front of the revenue cycle so the back end has something to collect.
What to confirm for every patient
A complete verification confirms primary and secondary coverage, member and group IDs, coverage duration, copay, deductible, coinsurance and benefit details — plus whether the plan requires pre-authorization or a referral.
- Primary and secondary coverage
- Member ID and group ID
- Coverage start and end dates
- Copay, deductible and coinsurance
- Authorization or referral requirements
Fix missing data immediately
Identify and resolve missing or incorrect data as early as possible. A phone call before the visit is far cheaper than an eligibility denial after it.
Look for hidden coverage
Electronically linking self-paid patients with managed Medicaid databases can uncover coverage patients did not know they had — raising self-pay revenue and releasing patients from costs they should not carry.
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