CureMed Solutions

Eligibility Verification and Securing Preauthorization

Eligibility Verification and Securing Preauthorization

The Change Healthcare 2020 Denials Index which is an analysis of 102 million hospital transactions valued at $407 billion in total charges across more than 1,500 U.S. hospitals, reports the average medical claims denials rate to be up by 23% since 2016, topping 11.1% of claims denied upon initial submission through the third quarter of 2020. Half of denials were caused by front-end revenue cycle issues; registration/eligibility, authorization, service not covered. The top denials cause was related to Registration or Eligibility, approaching 27% of denials and remained constant since 2016 followed by missing or invalid Claim Data leading to 17.2% denials. Authorization/Precertification related reasons were found to lead to 11.6%of total denials. It was found that 86% of denials were potentially avoidable; concluding that a lot of revenue loss is occurring that is preventable.

Curemed solutions possess a team with multiple years of experience in medical billing cycle provides you with:

Eligibility Verification and Securing Preauthorization

Accurate data checking:

  • Our team of experts thoroughly checks and analyzes all patient documents received from the healthcare organizations / insurance providers and verifies them against the list of the necessary documents.
  • We have best resources to verify benefits and eligibility through websites, automated voice response system and calling the Customer support center for all your patients, depending on the insurance payer.

Securing preauthorization/precertification:

  • We secure preauthorization/precertification from the insurance provider based on the insurance plan for health care service, treatment plan, prescription drug or durable medical equipment of medically necessity as and when needed.
  • Our team comprises of health care professionals with multiple years of clinical experience who guide in clinical documentation improvement, providing right diagnosis and correct medical codes that are very crucial in obtaining pre-authorization.
How outsourcing these services to us benefits you?
  • Clean Claim Submission for eligibility related errors to avoid hassles of claim re-submission.
  • Increased Cash Flow through increase upfront collections, decrease in write-offs and improved patient satisfaction.
  • Improves Efficiency by saving on time and resources, thus establishing an efficient and streamlined workflow.
  • Best in industry pricing scheme and exiting offers.
  • 100% HIPAA compliance and robust intrusion prevention service with fully managed firewall solutions and encrypted virtual private network.