Insurance verification forms the foundation of successful medical billing services. Without accurate eligibility and benefit information, even perfectly coded claims face denial. Our comprehensive insurance verification services ensure every claim starts with correct information, dramatically reducing denials and accelerating payments.
Studies show that 25% of claim denials result from eligibility or authorization issues – problems entirely preventable with proper verification. Our insurance verification process addresses real-time eligibility confirmation, detailed benefit breakdowns, copay and deductible amounts, prior authorization requirements, referral necessities, and coverage limitations.
When patients schedule appointments, our team immediately begins verification. This proactive approach identifies issues before service delivery, preventing surprise bills and payment delays.
Beyond basic eligibility, we investigate specific coverage for planned services, including procedure-specific coverage confirmation, frequency limitations, medical necessity requirements, network status verification, and secondary insurance coordination.
For services requiring authorization, we handle identifying requirements, gathering clinical documentation, submitting authorization requests, following up on pending decisions, and documenting approval details.
Our team navigates session limits and authorization requirements, carve-out plan complexities, and diagnostic requirements for coverage approval.
We verify implant and device coverage, assistant surgeon benefits, and facility versus office coverage differences to ensure complete authorization.
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