The insurance eligibility verification process is critical for all encounters, whether inpatient, surgical, or ambulatory treatment. This will ensure that the hospital/medical office collects credit for the care given and will assist with determining the patient's share of the hospital's costs, also known as the patient's duty. Eligibility verification is the process of confirming a patient's successful policy with an insurance provider and the legitimacy of his or her statements.

One of the main reasons for claim rejections or denials is because a patient is not eligible for services billed to the insurer by the provider.

Eligibility Verification if not done properly can lead to:

  • Delays in reimbursement from insurance companies.
  • Reduction in the percentage of the clean claims submitted.
  • High denial rate of claims and subsequent rework.
  • Decrease in profits for the provider.

We at Miraicure follow a robust eligibility verification process to identify and eliminate the problems at the source. Our Services include:

  • Collection of patient's plan information from the provider and also contact the patient in case of invalid or missing information.
  • We get in touch with the plan to obtain and verify complete information about the patient's plan and benefits. We verify the primary and secondary payer of the policy, the member ID, group ID, the start and termination date of the coverage, co-pay, deductible& co-insurance information.
  • Once we have obtained all the relevant information related to the patient's plan, we update the provider with the same.
  • Our verification team ensures accurate real-time data on patient gains before the visit. Alongside having experience in leading insurance companies in the country includes United Healthcare, Blue Cross Blue Shield, United Healthcare, AETNA, and GHI.