How Can Insurance Verification Specialist Help Healthcare Providers Operate Efficiently 29 Feb 2024

Claim denials can be complicated and irritating. They are the most common roadblocks to effective revenue cycle management. It not only takes more time and resources to handle the claim, but it also slows the cash flow. Poor insurance claims experiences may also pose a $170 billion threat to global insurance premiums by 2027.

Insurance Eligibility Verification is a necessary yet time-consuming process. As a result, it is best to contact an insurance verification specialist.

Next in Insurance: Top Insurance Industry Trends in 2024

Massive obstacles in recent years have driven insurance carriers as a whole to become more adaptive and technology-focused. Given the looming global recession and the continuous geopolitical instability, insurance businesses must continue to find cost-effective methods to innovate.

AI Adoption

As a technology driver, artificial intelligence (AI) is having a substantial impact on one of the most fundamental shifts in the insurance sector. As biosensors, intelligent devices, and deep-learning algorithms are integrated into goods, the insurance industry will see a significant change from “pay for damage” to “prevent damage.”

The growth of IoT and AI among the general population will render the existing technique of processing claims obsolete, paving the way for automated claim processing. As a result, firms must make plans and stay current on industry changes in the insurance sector.

Digital Convenience

91% of today’s insurance customers are willing to use online purchasing platforms and want their insurance firms to provide digital ease.

As a result, carriers and agencies should concentrate on making the client’s purchasing experience more digitally friendly. One approach is to enhance the application and intake experience across several scenarios and channels.

As consumers become more tech-savvy to make purchases, manage policies, make payments, file claims, and so forth, they are embracing trends in insurance technology. Customers’ experiences would be improved if they had more power and control. Businesses would benefit from this move as well, as it would lower the cost of client acquisition, increase insurance agent productivity, increase customer retention, speed up claim processing, and secure brand value and position.

Streamlining Mobile Applications

With mobile apps’ increased access to consumer location and key data, presenting tailored premiums is faster. Carriers that use mobile apps for policyholder acquisition, maintenance, and retention become long-term, critical partners by increasing the value they deliver to clients.

Today, insurance firms should prioritize comprehensive functionality, an appealing user interface, and highly tailored experiences. Prospective clients expect recommendations that are automatically filled in and rapid access to a human connection. To increase policyholder interaction, firms must integrate telemetry tools and provide simpler claim processing.

Concentrating on ESG

Environmental, social, and governance (ESG) efforts continue to be a strategic and compliance focus for insurers, presenting both a significant challenge and an opportunity to have a positive impact.

According to Capgemini’s research, 85% of global insurers anticipate that ESG will have an impact on all facets of their operations, with investments leading the way (91%), risk and internal audit following closely (90%), and underwriting (88%).

Implementing strategic ESG practices provides various advantages for insurers, including improved reputation, potential loss reduction, and contributing to a more eco-friendly environment.

Embracing Blockchain Technology

During the epidemic, cyberattacks against international firms increased by 81%. It is straightforward for tech-savvy con artists to target the insurance business. To that end, blockchain technology can aid in fraud detection and risk reduction. Operations will be secure and efficient, resulting in openness between insurers and reinsurers, smart contracts for insurance policies, and medical record encryption.

Businesses of all sizes should adopt blockchain into their core business processes and keep up with technological advancements in the insurance industry. They should become acquainted with the implementation of blockchain technology as it pertains to the insurance industry.

What does an insurance verification specialist do?

An insurance verification specialist verifies a patient’s insurance information and eligibility for medical care. They examine the patient’s insurance documents to assess their coverage and limitations before raising any issues with the supervisor for prompt resolution.

A position as an insurance verification specialist may necessitate post-secondary education in addition to a high school diploma. Certification may help, but is not essential. They must have prior expertise in customer service or a similar profession.

Why is insurance eligibility verification necessary?

Medical practitioners can estimate the patient’s financial liability by validating insurance coverage before the required surgeries. Verifying insurance coverage ensures that medical professionals get paid for the services they offer.

Insurance eligibility verification helps healthcare practitioners to assist their patients in acquiring all of the information they require ahead of time. Similarly, establishing insurance eligibility ahead of time protects healthcare providers from situations where insurance has lapsed.

Insurance Verification Checklist:

Many specifics, such as:

  • Patient’s name
  • Date of birth
  • Address Social
  • Security number
  • ID number
  • Insurance carrier
  • Plan type
  • Coverage specifics
  • Policy Status
  • Payable benefits
  • Plan exclusions
  • Co-insurance, co-pays and deductibles
  • Pre-authorizations and referrals
  • Health insurance quotas
  • DME coverage is one type of Medicare coverage.
  • And even more

How does the insurance eligibility verification process work?

To guarantee that insurance coverage is in place, all insurance eligibility verification services follow a standard method.

Insurance Verification Checklist

When checking insurance, ask the right questions. Front-desk personnel should enter data collected from the insurance card, phone calls with the insurance provider, or electronic eligibility systems. To validate insurance coverage, each patient’s electronic medical record should have the following information:

Patient Insurance Card Copy.

Request a copy of the patient’s most recent insurance information to collect data for the insurance eligibility verification. If the insurance information was entered erroneously, your electronic health record now includes an updated snapshot of the insurance card on both sides. Before submitting claims, medical billers should ensure that the ID numbers on the cards match.

Contact the Insurance Provider

To verify eligibility, contact the insurance carrier directly. Call the provider hotline or utilize your connected EMR and billing system to contact major payers such as Medicaid, Medicare, or Blue Cross for eligibility information.

Keep Records

Take special care when entering patient information into the patient record. Because the data serves as the foundation for the medical claim, a single missed statistic can make the difference between a clean claim and a denial. Rushing through insurance verification processes and submitting erroneous data may result in payment delays of several days or weeks or even a complete claim denial.

Follow Up

If the patient has any questions or concerns about his or her insurance, follow up with him or her. Use a patient portal for email or online interaction to advise patients of eligibility, or phone the patient to alert them of copays or other problems.

Update Billing Software

To generate medical invoices, and update the information on insurance coverage, pre-authorizations, and specific patient information.

5 Reasons to Hire a Virtual Insurance Verification Specialist

The insurance verification process has grown noticeably in recent years. It is essentially a result of the elevated priority given to streamlining administrative procedures, enhancing cash flow, and lowering claim denial rates.

Insurance eligibility verification

Source: Benzinga

The above market research analysis for 2023–2030 depicts the present situation and potential growth of the “Insurance Eligibility Verification Market.”

According to projections, the worldwide insurance eligibility verification market will surpass $1 billion by 2030, growing at an astonishing CAGR between 2023 and 2030

Verification of insurance is required to ensure that the services are paid for. Misverification of insurance coverage can delay reimbursement, deny claims, and postpone patient visits. Top five reasons to use virtual insurance verification specialists:

Simplifying Verification to Reduce Time and Effort:

Eligibility for Outsourcing Insurance Verification by a trained team with a systematic procedure to handle every verification, from phoning the insurance company to documenting the most recent updates to the insurance policies, will help you get your claims processed faster. It will reduce unnecessary delays.

Cut down on claim denials and wait times:

An outsourcing firm is skilled at filing more accurate claims. They are experts at detecting bogus information, reducing the need for claim rework.

Improve Patient Satisfaction and Reimbursement:

Virtual insurance verification professionals have access to up-to-date information about insurance eligibility. They can tell the patient if they are eligible for insurance coverage. Furthermore, they enhance the likelihood of claims being authorized, processed efficiently, and paid out on time.

Address Security Issues

On their portal, hospitals save a large amount of patient information. These facts are available to hackers, who may use them for financial advantage. Maintaining the confidentiality of sensitive personal information in medical records is thus required by law and morality. Addressing cybersecurity challenges and staying current with technological improvements for data protection is crucial for this. A reliable virtual insurance verification specialist supplier with specialized instruments can provide you with the best safety instructions.

Cost-Effective Solution:

An outsourcing organization provides high-quality insurance eligibility services at a reasonable price. A medical billing business that outsources has the cutting-edge infrastructure and trusted staff to process your claims quickly and correctly at a fair cost.

End Points

Virtual insurance verification specialists provide numerous benefits. This requires medical practitioners to engage trained insurance verification specialists, which can be time-consuming and exhausting. Velan can help with this. Velan is a pioneer in providing trained insurance verification specialists to prevent the dangers associated with denials, incorrect insurance eligibility, and benefits. For the past 17 years, Velan has provided flawless end-to-end medical claims processing services.

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals. He can be reached at


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