Insurance verification is a critical component in any pharmacy revenue cycle management. As per industry data, more than 70% of all billing claim denials occur due to incorrect billing by the pharmacy practitioners to the insurer. There are occasions when policies are modified, employees switch plans for better benefits, policy gets terminated or expired etc. which may result in denial of pharmacy benefits to the patients. These dynamic changes make the process even more critical for accurate verification.
MBC launches customized insurance verification services for pharmacy billing providers, helping them in claims management and overall revenue management for pharmacy billing. Our experienced agents carefully analyze and check the status of the insurance policies with regards to plan exclusions, modifications and other criteria related to a patient’s eligibility process.
MBC’s customized insurance verification covers all steps such as:
- Accessing the details of the patients though secure channels like Fax, FTP, secure email and Practice Management Systems
- Coordinating with the insurance companies for patient’s insurance coverage, verification, co-pay information, demographic information, benefits information, coverage start and end dates, billing system update, member ID, group ID, Pre-certifications and any authorization required in case of any emergencies
- Verifying patient’s coverage on all primary and secondary payers and resolving coverage issue (if any) prior to patient treatment
- Updating the verified results with the practice so that they can discuss the payment options with the patients at the time of their appointment.
Advantages of verification services for pharmacy billing providers:
- Minimize claim denials and payment delays
- Timely reimbursements
- Cost savings of up to 30-40% by reduction in claim rework time
- Cost-effective and quick services
- Expertise in gathering complicated verification requirements
- Insurance verification’s to be complete before the patient’s appointment
- Experts work with patients and payers to verify medical insurance coverage and generate claims for services rendered
- Verification of :
- Effective date and coverage details
- Individual patient eligibility
- Type of plan
- Payable benefits
- Claims mailing address
- Referrals & pre-authorizations
- Pre-existing clause
- Life time maximum
- Other related information
As a leading global medical billing and coding outsourcing company, we work with advanced technology and deliver on-time, precise and customized insurance eligibility verification for pharmacy services. Being HIPPA compliant, we have timely QA checks in place to provide high quality accurate solutions. Apart from reducing a practitioner’s time and bandwidth spent on insurance verification, we provide value-added services by getting more returns out of their investments.