Patient Eligibility Verification

Helping providers in submitting clean claims

Our Pre-Authorization and Eligibility Verification Services Are All You’ll Ever Need!

Patient Eligibility Verification is considered to be an initial step in the revenue cycle management that enables medical practices to see whether a patient is eligible for the treatment. It includes the breakdown of benefits and checking whether the healthcare service is covered by the patient’s insurance or not, along with other benefit options such as copays, deductibles, and co-insurance as well. 

Verification of Eligibility is highly crucial to a medical practice overall. According to reports, approximately 70-75% of claim denials occur primarily due to errors or mistakes in the eligibility verification of patients by healthcare providers. This shows us that most practices are still not paying due attention to their eligibility verification processes, and paying its price in the form of claim delays and denials. Nevertheless, we at Skyshine Health Solutions are providing medical practices with a solution. Our Eligibility Verification services for physicians and private practices are devised to provide you with leverage in the medical billing domain. 

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    Eligibility Verification is More Important Than You Might Think!

    Many physicians and private practices think of eligibility verification as a formality that is mostly overshadowed compared to the other steps in the revenue cycle management system. This is why the highest rates of claim denials are caused due to mistakes in a patient’s eligibility verification. To further add insult to injury, the claim denials are mostly non-appealable and irreversible because they fall in the category of hard denials. As a result, medical practices have to bear monetary costs along with a highly negative impact on the healthcare practice’s overall reputation as well. 

    As mentioned earlier, the first and foremost phase of the medical billing process is eligibility verification. A practice can only receive timely payments if insurance verification is done correctly. As a medical practice, you need to verify the patient’s eligibility before rendering any service. In case you fail to address the eligibility verification problem at the earliest, you are going to face delayed payments and even denials. As a result, it leads to lesser revenues and greater claim denials. This is where our Eligibility Verification services come in handy as you can easily hand over the job to our experts and focus on patient care for the best results

    Credentialing and Enrollment FAQs

    1Why is eligibility verification necessary for medical practices?

    Medical practices have to make sure that the healthcare services they’re offering are actually covered by the patient’s insurance. This is why they have to perform eligibility verification for the purpose. 

    2Why outsource eligibility verification to Skyshine Health Solutions?

    Skyshine Health Solutions is a professional RCM Billing company that ensures proper eligibility verification and breakdown of benefits for medical practices to avoid any chance of claim denials affecting a practice’s overall revenue. 

    3What is meant by a Breakdown of Benefits?

    The term Breakdown of Benefits (BOB) is used to represent the act of checking for co-pays, deductibles, coinsurances (%), or other non-covered amounts that are to be paid to medical practice or physicians by patients. 

    4How much time is needed for insurance verification?

    The usual time required for verification of benefits takes 20 minutes. However, it is recommended that you get in contact with the payer 72 hours before the appointment of the patient.