Eligibility, Benefits Verification, and Prior Authorization Services

What Are Eligibility, Benefits Verification, and Prior Authorization?

Eligibility and benefits verification alongside prior authorization are critical components in the healthcare revenue cycle, ensuring that services rendered are appropriately compensated. Verifying each patient’s eligibility and benefits before their visit is crucial as estimates suggest that up to 75% of claim denials stem from eligibility issues, making it a frequently overlooked yet vital process. Prior authorization also plays a key role by confirming coverage before procedures, thereby preventing delays and denials. The Impact of Ineffective Processes Ineffectively managed eligibility, benefits verification, and prior authorization processes can lead to increased claim denials, payment delays, unnecessary administrative rework, reduced patient access to necessary care, decreased patient satisfaction, and ultimately, loss of revenue. ScribeRunner’s™ Expertise ScribeRunner™ brings a team of specialized experts dedicated to optimizing your accounts receivable cycle. By ensuring all necessary patient eligibility and prior authorization checks are completed before the patient’s visit, we help streamline billing processes and enhance financial outcomes. Our Team’s Approach Our team members meticulously perform the following as part of the verification processes:

Step: 1

Obtain the patient schedule from the healthcare provider’s office, whether it’s a hospital or a clinic.

Step: 2

Enter patient demographic information into our secure system.

Step: 3

Confirm benefit coverage details with the patient’s primary and secondary insurance providers, including:

Valid coverage on the date of service.
Patient responsibilities for copays, coinsurance, and deductibles.

Step: 4

Initiate and process prior authorization requests as needed to secure approval for treatment.

Step: 5

Update the practice management systems with payer details to ensure accurate billing and continuity of care documentation.

Key Benefits of ScribeRunner’s™ Eligibility, Benefits Verification, and Prior Authorization Services

Save over 40% in Operational Costs

In-house verification processes can significantly increase overhead expenses. By outsourcing to our dedicated team, operational costs are substantially reduced as we efficiently manage and process each request with precision and diligence.

Enhance Speed to Care Delivery

Efficient prior authorization processing enables quicker scheduling of patient care reviews, significantly improving patient satisfaction and optimizing physician utilization.

Minimize Claim Denials

Enhancing eligibility verification and prior authorization processes leads to fewer claim denials and faster cash flow, streamlining financial operations.

Reduce Bad Debt and Improve Cash Flow

Determining patient payment responsibilities upfront minimizes bad debt and elevates point-of-sale (POS) collection rates, while simultaneously improving patient satisfaction.

Broad Healthcare Expertise

Our team collaborates with leading commercial and government healthcare payers, including Blue Cross Blue Shield, Aetna, Humana, United Healthcare, among others. We serve a diverse range of medical specialties, spanning multiple states and accommodating practices of all sizes.

Empower Business Growth

By managing the entire verification and prior authorization process at less than a third of the typical costs, we enable your team to concentrate on what truly matters: expanding your business and delivering exceptional patient care.

In conclusion, ScribeRunner’s™ Eligibility, Benefits Verification, and Prior Authorization Services not only streamline your administrative processes but also empower your team to focus on critical areas: expanding your practice and enhancing patient care. By entrusting these complex tasks to our expert team, you secure financial benefits through reduced operational costs and improved cash flow, ensuring your practice can thrive in today’s competitive healthcare landscape.