Eligibility & Verification Services

To obtain timely and accurate data regarding every patient’s insurance coverage, the processing of eligibility and verification of insurance benefits is critical.  Eligibility and verification processes also allow you to ascertain every patient’s financial responsibility toward the healthcare services you provide as well as clarity on each patient’s out-of-network benefits.  

Many medical practices fail to perform this function effectively either due to lack of process knowledge or a lack of time due to front desk staff overwhelmed with a hectic patient schedule, thereby resulting in workflow delays in the waiting room as well as in the back-office clinic for the providers.  In addition to workflow delays, incorrect insurance eligibility information could cause delays in reimbursement or even unnegotiable payment denials.

By properly executing eligibility and verification checks on a daily basis prior to the clinic opening, as Avosina does for all of its clients, enables the submission of first-pass clean claims that get paid on time and in full by payers.  This process avoids the need for claim re-submission, a decrease rejections and denials due to a lack of eligibility or improper demographics, and a maximization of front-end collections.  With less touch points and rapid turnaround, you enhance your cash flow, optimize reimbursements, and increase patient satisfaction all at once. 

Avosina’s Eligibility & Verification Services

• With you as our medical practice client, we will have access to the eligibility and verification workflow through your EMR’s patient schedule
• We will run the eligibility check and verify primary, secondary, and tertiary coverage details, including coverage period, member benefits data, member ID, group ID, deductible amount, co-pay/co-insurance data, and accurate demographics.
• We harness the necessary medium to connect with the payer (web, phone, etc.) via manual checks and automated systems.
• In the event of incorrect data, we will inform the office and contact the patient.  

Value we add to you with Avosina’s Eligibility & Verification Services

• Enable front-end revenue collections from patients with accurate data for front desk
• Maximize back-end billing collections
• Accelerate cash flow
• Mitigate rejections and denials
• Increase patient satisfaction