Eligibility and Benefits Verification

Eligibility and Benefits Verification is the important part of patient care that will help determine if and how much the provider will get paid for services rendered to the patient. Improper or incomplete eligibility verifications will lead to denials and loss of the revenue for the practice. Most common reason for eligibility denials is the patient’s insurance is terminated, or the patient insurance on file is old or incorrect one. In many cases, practices continue to provide services to the patient without realizing the patient doesn’t have an active insurance on file, compounding their revenue loss.

Prior Authorizations

Prior Authorizations for visits and procedures are another important component of patient care that will affect practice revenue. While proper Eligibility Verification will determine if prior authorization is required, if the prior authorizations are not done properly, it will lead to denials and non-payment. For many specialties, where significant reimbursement comes from procedures, this could lead a major revenue loss for the Practice.

Benefits of outsourcing with Finch

• Highly skilled personnel at Finch understand the nuances of Eligibility Verifications and Prior Authorizations across many specialties.
• Finch works with practices on providing a customized workflow so all E&B verifications are done well ahead of time before the patient is seen.
• If Prior Authorizations are needed, Finch will review the provider notes to understand and request authorizations for the Insurance Companies.
• Finch uses proprietary software to track and manage all Eligibility and Prior Authorization Requests.