Insurance Verification software/service

Our front office staff spends a lot of time when a patient comes for the office visit and immunizations to verify to see of they have active insurance or not. With the the high cost of purchasing the vaccines it is very expensive to write it off. Any advise on how to verify when patient is already at the front office with a new insurance card to see if it is active and vaccines and office visit is covered ?

our emr- athena, does it for us

Our EMR MicroMD also does it for us. Also you can check if your clearinghouse has the service. The other option is to have access to the insurance websites and save them as favorites. Our staff checks eligibility in the morning for all patients that are scheduled to come that day. You can do it the day before, but sometimes their insurance is active the day before but is inactive the day of the appointment. This is often true with Medicaid coverage. When patients call for same day appointments, the eligibility is checked as soon as the appointment is made. If we find the insurance is not active, then we call the parents before they come for their appointment.

Our EMR (eClinicalWorks) by way of our Clearinghouse (Waystar, formerly Navicure) dose eligibility for us. Your office work flows should have processes in place to prepare for patient visit “ahead” of time unless you have $$$-margins to offset potential losses.

Alternatively, log into each payer’s web site and review eligibility and plan benefit information. This is always a resource regardless of EMRs and Clearinghouse.