- Verify patient insurance eligibility and coverage prior to scheduled services.
- Review active/inactive status, effective dates, termination dates, plan type, and coverage details.
- Verify patient benefits
- Verify perks for specific CPT/HCPCS and procedure codes when required.
- Identify primary, secondary, and tertiary insurance coverage.
- Confirm coordination of benefits (COB) information when applicable.
- Review payer-specific requirements and benefit limitations.
- Accurately document verification results in the designated system.
Authorization Management
- Obtain authorization from insurance companies through payer portals, phone, fax, or other approved channels.
- Submit authorization requests with accurate patient, provider, diagnosis, and procedure information.
- Track authorization requests from submission through approval, modification, or denial.
- Maintain accurate authorization numbers, approved CPT codes, units, dates of service, and validity periods.
- Identify services that require authorization and communicate requirements promptly to the appropriate internal teams.
- Follow up with payers on pending authorization requests.
- Ensure authorization information is available and accurate before the date of service.