Data-Driven Automation: Optimizing Insurance Verification

A closer look at how data can deliver vital insights to the healthcare industry.

The Challenge

When patients neglect to notify their doctor’s offices about changes in health insurance before appointments, it can set off a chain reaction of challenges — from slow check-in processes to potential payment delays and rejected claims. Common challenges include:

• Time spent manually verifying insurance
• Wasted time on initial claim processing
• Extra staff effort reviewing rejection reasons
• Repeated phone calls to reach patients
• Re-filing insurance claims
• Uncertain outcomes (payment delays, rejections or write-offs)

The Solution

To improve operational efficiency, we recommend introducing an automated pre-check process, ensuring the following steps are completed on the first of every month:

• Pull Accurate Records: Extract and consolidate real-time insurance information from electronic health records (EHR). 
• Conduct Initial Verification: Automatically cross-reference data with the Availity network. 
• Flag Discrepancies: A streamlined report allows staff to proactively identify misaligned information and get a head start on investigations.

The Outcome

An automated pre-check process streamlines the experience for both staff and patients, potentially reducing administrative bottlenecks, speeding up check-in processes, improving the rate of successful claim submissions — without labor-intensive re-filings — and allows for faster payment processing.