Why Do Verification?
Q. Why do verification of your customers insurance eligibility before performing services?
A. Simply presenting a Medicare or Insurance ID card is not a guarantee that your claim will be paid.
Co-Pays and Deductibles can vary from day to day. Knowing how much to collect from your patient up-front means a solid cash-flow.
We analyzed a portion of the inquiries sent by our customers and here is a summary:
201 Inquiries were submitted. 201 Responses were returned.
| Percent of Responses |
Number of Responses |
Reason for the rejections |
| 18.41% | 37 | "patient not found" - this means there is no such name or Health Insurance Claim Number (HICN) on file. |
| 1.99% | 4 | "no alpha suffix" - HICNs one of the following character suffix - "A","T","TA","M","M1","J1","J2","J3","J4". |
| 10.45% | 21 | "DOB didn't match HICN" - The DOB on the inquiry didn't match the DOB for the HICN on CMS' file. |
| 1.99% | 4 | "Wrong gender" - The Name, DOB and HICN matched, but the submitted gender didn't match gender on file. |
| 1.99% | 4 | "Benefit inactive" - no entitlement information, - unlawful resident, - deported, - incarcerated, - deceased |
| 14.43% | 29 | "Medicare not Primary Payer" - The primary payer's name, address and membership ID is displayed. |
NOTE: All of these claims, if sent in with the known information, would have been denied by CMS.
By doing pre-verification, your staff will get the right information beforehand.
A simple analysis of just one of our customers showed that using our service saved them over $87,000 in a single years time by simply knowing ahead of time to collect the Deductible on CMS claims.
Can you leave $87,000 out of your cash flow, having to chase that money later on?
Even with resubmitting corrected claims to CMS, costs are estimated at $10 to $20 per claim.
CMS statistics are that 40% of "denied Payment" claims are not resubmitted, primarily because of the correction costs. This is lost revenue to the practice.
The below were returned with valid information and eligibility verified and can be used to submit CMS claims.
| Percent of Responses |
Number of Responses |
Reason for the rejections |
| 50.75% | 102 | "inquiries found" - All the information found matches the inquiry including eligibility of services. |