A Complete Guide to Patient Insurance Eligibility Verification

Your practice management system is absolutely necessary to run your practice properly, but without complete and accurate information, it can’t formulate appropriate treatment plans for patients or meaningful revenue projections for you.

The perils of magical thinking

An automated system with that special button” or third-party software will only send a request to the patients insurance carrier for verification information. And that’s only if your system has a relationship” with that carrier. If not, youll get zero information. Even with a relationship, you’ll get only the information the carrier chooses to send.

Meaning, you probably won’t get enough of the right information to help prepare a proper treatment plan. So not only doesn’t the treatment plan happen magically (aka automatically), but your staff will still have to call the insurance carrier.

More magical thinking madness

When you do get the information, it has to be entered into the patient record of your practice management system, and a plan still has to be created in order to prepare claims and treatment plans.

But what about the magic button that gets and sends…things? Formats differ among insurance carriers, information is inconsistent, and practice management systems each have their own specifications for accepting data. As you can imagine, there are many opportunities for systems to NOT work well together.

What about insurance carrier websites?

Sure, a lot of large payers have websites with information for verifying patient eligibility and benefits. Here’s the but:

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