Insurance Eligibility Verification

• Verify patient insurance eligibility using insurance payer websites, clearinghouses,

and outbound calls.

• Confirm active insurance coverage before scheduled appointments or medical

procedures.

• Validate patient demographic information and insurance details.

• Ensure all insurance information is accurate and up to date in the practice

management system.

Benefits Verification

• Verify and document:

o Co-payment

o Deductible

o Co-insurance

o Out-of-pocket expenses

o Coverage limitations

o Lifetime benefits

o Network participation

• Determine covered and non-covered medical services.

Prior Authorization & Referral Verification

• Verify whether prior authorization is required for scheduled procedures or

treatments.

• Identify referral requirements based on insurance plans.

• Coordinate w...