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Why is checking eligibility so important?

Checking Eligibility

With there being more insurance plans and with patient’s insurance plans changing frequently, it is invaluable to understand what insurance they have, what plan they have, and what their benefits and coverage are. Not knowing this can result in claims not being correctly processed and a delay in payment.

Here are some points to follow to ensure proper information is obtained prior to the patient being seen. It ultimately will save you time.

  • Please note that patients who may have had Medicare or state they have Medicare, may in actuality have a Medicare HMO. If you are checking eligibility you will be able to easily obtain this information by listening to the complete automated message. If you are unable to verify eligibility, please ask the patient if they have another insurance card, aside from their Medicare card. If they present you with a Medicare card and a Managed Care card, the Managed Care is their primary insurance.
    • Of course the patient may have a second and third insurance, which you will have to ask for as well.
  • Medicaid – Patients who had Medicaid, may now have a Medicaid HMO plan. Please ensure you ask for their updated insurance information or confirm what HMO they have when verifying eligibility. If a card says Amerigroup, it is important to understand if the patient has Amerigroup Medicare or Amerigroup Medicaid.
  • PCP – it is essential that you know if the patient has chosen you as their PCP. At times, the patient’s plan changes and you are no longer their PCP. Their plan may change without the patient’s knowledge. Therefore it is important that this information be checked.
  • Timely filing limits have changed for insurances – such as for Aetna. This means that obtaining correct insurance information on or before the time of service is proving to be more crucial. It is also important to submit charges to us in a timely manner