Benefit & Insurance Verification

Industry sources state, 70 to 75% of all health care claim are denied are due to a patient not being eligible for services billed to the insurer by the provider. Often, a patient would be ineligible for benefits because his or her policy has been terminated or modified, specific services are ineligible or benefits are limited.

NWRCM can assist practices reduce their denials and its accounts receivable cycle while increasing revenue. In the verification of benefits we dramatically reduce the impact of ineligibility and increase the number of claims that are sent to insurers for adjudication. Benefit and eligibility verification is one of the most neglected elements that impact collections in the revenue cycle of the health care industry.

In the absence of proper eligibility and benefit verification countless numerous problems are created i.e., denied or delayed payments, reprocessing, decreased patient and staff satisfaction, increased costs of denial and appeals management. To avoid these problems, NWRCM deploys staff, technology, expertise and management delivering cost effective patient benefit and insurance eligibility services.

NWRCM Eligibility Verification Services has the potential to:
› Improve cash flow
› Decrease denials and appeals of claims
› Decrease providing non covered services

Our Insurance Eligibility & Benefits Verification Services Include:
› Obtain Schedules from the practices via various forms of media
› Verify coverage on all Primary and Secondary Payers (if applicable)
› Contact patient for information if necessary (Client Option)
› Provide the client with the results which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay/co-insurance information in and out of network deductibles with maximum spending amounts.

Related Services (optional):
› Obtain Pre- Authorization Number
› Obtain referral from PCP
› Update Patient demographics
› Remind patient of patient payment requirements
› Inform client if there is an issue with coverage or Authorization