Eligibility and Benefits Verification
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.