Eligibility Verification & Authorization

Eligibility Verification & Authorization

E&B verification is a critical part of medical billing that ensures healthcare providers receive timely and accurate payments for services rendered. Here are some key points about our E&B verification process:

Eligibility Verification:

• Verify active coverage with the patient's insurance provider
• Determine the type of plan the patient has
• Check if the patient's plan requires a primary care physician (PCP)
• Determine if the provider is in-network or out-of-network
• Verify the patient's responsibility for the office visit, including deductible, co-pay, and co-insurance
• Obtain the claim submission address and payer ID (if necessary)

Benefit Verification:

• Verify coverage specific to the services to be performed
• Determine if authorization and/or referral is required for the services
• Determine the patient's responsibility for the services

For scheduled appointments, we follow this E&B verification process:

• Obtain the patient's schedule from the provider's office.
• Verify coverage of benefits with the patient's primary and secondary payers, including general coverage and benefit verification.
• Initiate authorization requests (if required) and obtain approval for the treatment.
• Update the EHR software with all the necessary details.

We prefer to receive schedules three days ahead so we can provide details within 24 hours. This allows the provider to call the patient in advance if there are any issues with their insurance.
For walk-in patients, we prioritize completing verification requests as soon as possible, ensuring that providers can see patients promptly.

At Medicagrow, we pride ourselves on delivering a cost-effective and efficient E&B verification solution that saves healthcare providers time and resources. Contact us today to learn more.