Insurance & Eligibility Verification

Determine Coverage. Reduce patient and eligibility related denials. Improve cash flow.

Atom Healthcare’s patient registration services involve collecting the patient demographic information, insurance/payer information, and other details to reduce claim denials. Our team captures the following information with the highest quality and within the turnaround time:

  • Patient’s demographic details including name, gender, address, phone numbers, and social security information
  • Medicaid or Medicare cards for patients receiving federal or state assistance
  • Information about the Payers
  • Insurance information (Name of the insurance company, group and policy number, name of the insured person and his/her contact information, and mailing address for claims)
  • Self-Pay/Patient Responsibility (Name, address and telephone number for person who will be responsible for payments)
  • Special requirements (interpreter, stretcher access, etc.).
The process for Insurance and eligibility verification (financial clearance outsourcing) involves:
  • We receive the work queues to be processed through the provider’s patient scheduling system, faxes, or through .csv/.txt files via FTP.
  • We verify type of plan, primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, claim mailing address, referrals and prior authorization, pre-existing clauses, deductible / co-insurance information, and benefit information
  • We also verify if any pre-certification or authorization is required and determine the appropriate channels (calls/web) to connect with the payer to receive the information.

Timely performance of Insurance eligibility information helps in minimizing Claim Rejections and Denials

  • Improving first pass rate
  • Avoiding claims re-submission
  • Reducing demographic and eligibility rejections and denials
  • Determining patient responsibility clearly and propose payment plans
  • Increasing self-pay collections
  • Improving patient satisfaction
92%
of consumers want to know
payment responsibility prior
to a provider visit.
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