Struggling With E&Bs And Auths?

Have you conducted your 3rd quarter eligibility and benefits checks?

Not all client health plans are on a calendar year. Some copays and deductibles reset throughout the year.

• Asking the right questions when calling to verify benefits will assist with financial planning and proper collection of payments.
• Verifying the insurance plan to confirm coverage is active and no changes have been made ensures you will be paid for the services you provide.
• Coordination of benefits should be kept up to date because it directly affects any authorizations on file.

Are your authorization being requested in time to avoid a lapse in service?

Improper management of authorizations can lead to claim denials, postponed sessions, and can strain your client relationships.

• Timely authorization submissions prevent delays in medically necessary services.
• Don’t assume insurance companies will back date your authorizations as many, including Tricare, will not.
• Allow time for unforeseen requests by the insurance companies (e.g., updated medical documentation, peer-to-peer reviews, etc.)