Automated Eligibility Verification – The Most Efficient Way to Perform the Most Critical Step in Medical Billing

If you’re not checking eligibility, you risk not getting paid.

If you’re manually checking eligibility, you’re wasting time on something that can be automated.

Nobody wants to work for free! But that is exactly what happens when a patient is seen, and the claim for services rendered is uncollectible because the patient didn’t have coverage.

The cost of that service extends beyond just the providers’ time. There is also cost associated with the staff that scheduled the appointment and checked the patient in and out. There is also cost associated with the nurses, medical assistants, and billers that took the time to send out the claim. The most critical step in medical billing is verifying patient eligibility before the patient is seen. There is a good, better, and best way to check patient eligibility!

When to check eligibility:

New Patients

When a new patient calls to schedule an appointment, an office should first ask for insurance information and run an eligibility check to verify coverage. It’s not just good for the practice; it’s a matter of good customer service. 

No patient wants to find out after their service that the practice doesn’t take their insurance or that they are out of network. Having information regarding coverage and the deductible allows practices to have up-front conversations with new patients to make informed decisions.

Scheduled Appointments

There are so many factors that can impact changes in healthcare coverage. Lost jobs, employers changing insurance companies, employees selecting a different option offered by their employer, deciding to switch coverage to a spouse’s plan, and on and on.

These changes can come at any time. Because appointments can be scheduled months in advance, verifying eligibility for every appointment a few days prior is best practice. This allows the practice time to address eligibility changes with a patient before seeing them.

And just as a tip- if the appointment falls on the first day of the month, it’s always a good idea to recheck it that day because most plans term on the last day of the month.

The “good/better/best” for verifying eligibility:

Good: Call the insurance company to verify.

The downside of this method is that it can take a lot of staff time. Even if you have a dedicated staff member to make calls for all scheduled appointments, they can’t always get it done. It is common for staff to get interrupted with other duties or get stuck waiting on hold for extended periods. And because of how much time it can take, there is an increased risk that it won’t ever get done.

Better: Verify eligibility online.

Many insurance companies allow you to verify insurance through their website or the clearinghouse. While this is more efficient than calling the insurance and getting stuck on hold, it is still a manual process to go to the site or clearinghouse and key in the information. The impact of this method is the drain on staff time and a high risk that it won’t be completed 100% of the time.

Best: Real-time and Scheduled Eligibility checking directly from Medisoft. 

When you use Medisoft EDI, you unlock the real power of automation because everything is tightly integrated directly into Medisoft.

For example, when registering a new patient, you can enter the insurance information and do a real-time eligibility check with the click of a button. No leaving the window, no making phone calls, and no re-entering the same patient demographic and insurance information over and over! Eligibility information is pulled right back into Medisoft in the patients’ case and in Office Hours.

What about all those scheduled appointments? Medisoft can automatically run eligibility for an entire day of appointments all at once a few days in advance. This way, you know which patients still have coverage and which ones to reach out to before they come. Real-time checks can also be done when scheduling existing patients to verify the insurance on file is up to date.

Are you ready to automate eligibility checks?

Learn how to automate eligibility in Medisoft with this video.

Automating eligibility is so easy, and is super helpful to your practice!

  • Save time by not being on the phone for hours
  • Save the hassle of rescheduling and canceling appointments
  • Maximize profits by avoiding seeing patients for free!

On top of this, check out the 6 Ways the Medisoft Clearinghouse will legitimately save you boatloads of time and money in Medisoft

Read the post here: 6 Ways Medisoft EDI saves you money

Give us a call today!

We know firsthand how scary it can be to switch to a new clearinghouse. Rest assured, we’ve helped hundreds of practices make the switch, and we’ll make it a quick and painless process for you.

Call us today to ask your questions, to get the details, and to discuss the process for moving from your current clearinghouse to the Medisoft Clearinghouse.

Let us help you get to a place where you can enjoy extra time, a streamlined and straightforward electronic claims process, and maximized revenue.

AZCOMP Technologies – the #1 eMDs reseller for Medisoft since 2005.

We are the ultimate source for all things Medisoft. Whatever your question, problem, or need with Medisoft, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as the Medisoft preferred clearinghouse, patient statements, patient payments, appointment reminders, and more.

For more information, visit our website here:

Be sure to call us at (480) 730-3055 for all your Medisoft and healthcare technology needs.