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New Year - Verifying Insurance

Kaia Ellis 3 years ago in Clients Module updated 3 years ago 10

We are looking for tips and ideas for making our processes more efficient with regard to verifying client insurance and updating their benefit information as of the first of the year.  We are running into a seemingly never-ending abyss of stacks of paperwork that need verifying, and we have more clients than last year, which has us a bit worried about the upcoming task at hand.  With long wait times for calling to check benefits, updating information in a timely manner is nearly impossible.  We are thinking about adding temporary staff, thinking about efficient ways to use and train them - AND we would be interested in any procentive ideas that may be helpful, or any workflow ideas and processes that work well for you to keep this moving along and as efficient as possible.  Thanks! 

Do you have access to all the carriers' websites?

Do you have any ideas re: what my co-worker Tina explained? 

We have many different groups and IOP Programs and many special codes. There are different benefit levels and we need to check benefits for IOPs, Intensive Groups, Dietitians. Checking on line does not give the specifics that we need, therefore, we need to call the insurance companies. We do run an eligibility checks every month via Procentive and using the insurance companies website. Our dilemma is the first of the year. We have all clients fill out an Updated Insurance Form. This way we have updated signatures and signed releases. We are looking to see if anyone has any workflow ideas. We have 38 providers. Wondering how many Administrative employees people have as well.

We call on benefits upon intake to make sure our services are covered and no authorization is needed. We then run eligibilities through MN-ITS and the carrier websites at the first of each month to make sure that nothing has changed. That way we have verified insurance coverage before any services are billed.

Tessa's protocol makes sense.  Also, it is my understanding that, for MN providers with a DHS contract, our contract requires us to routinely "check benefits before provider the service."  Checking MA benefits at the start of the month is savvy because if a person loses their DHS benefits temporarily (happens to tens of thousands of people every year), then you catch it before seeing the person and submitting a claim which will be denied.  The benefits are often reinstated, but it is a hassle to have to track this and resubmit - best to proactively confirm MA benefits at the start of the month. 

Do you run into any issues with discrepancies between medical benefits and mental health benefits?

Yes, we do this at intake as well.  Can you describe your process - how many people are calling to check benefits, and logging in to carrier websites, how long it takes per client, updating procentive, etc?  I think we have the process pretty well managed at intake, but it's the re-checking process that we're trying to be more efficient at.  

We check eligibility at the beginning of each month to insure that payers have not changed or the client hasn't dropped off or switch payers. 

We have a large pool of clients, I'm wondering if you could describe how you manage this task every month for all of your clients?

Kaia,

We only provide mental health services so when we call the insurance company upon intake to check their benefits, we ask about the specific service that we are providing and the codes we will be using. That way we are very clear and they do not confuse us with medical benefits.

As for eligibilities, there are only two of us in the billing department and we print off spreadsheets with our clients names, DOB, insurance ID numbers to make it easier to run eligibilities. I also know that Procentive has an option to run eligibilities through their "payers" portion in the client module, but we rely on the DHS website since we find that to be the most accurate.

I work with Kaia......

We have many different groups and IOP Programs and many special codes. There are different benefit levels and we need to check benefits for IOPs, Intensive Groups, Dietitians. Checking on line does not give the specifics that we need, therefore,we need to call the insurance companies. We do run an eligibility checks every month via Procentive and using the insurance companies website. Our dilemma is the first of the year. We have all clients fill out and Updated Insurance Forms. This way we have updated signatures and signed releases. We are looking to see if anyone has any workflow ideas. We have 38 providers. Wondering how many Administrative employees  people have.