by  Codapedia
November 19th, 2015

By: Codapedia Editor (Mar/30/2009) 

One of the most common sources of denials in physician practices is "patient not eligible for this date of service."  The patient presents with an insurance card, the office copies the card, and stores the information.  The practice provides service, and perhaps collects a copay, and then submits the claim to the insurance.  Two or three weeks later, the practice hears back from the insurance company with a denied claim.

What can a practice do to prevent these denials?  Check on the patient's eligibility prior to providing the service.

How?

• Manually, by calling the insurance company.  This is time consuming.
• On the plan's website.  Also time consuming.
• Through an electronic interface between your practice management software company and the insurance company, done in batches a few days prior to the date of service.
• Through a software company that interfaces with your practice management software and checks eligibility with many insurance companies.

It is good practice to use one of the methods prior to every patient visit.  Paying for a software interface, and then paying a few cents/patient is probably the most cost effective, when you factor in staff time.

References:

• Original article on Codapedia.com

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