How to Verify Patient Insurance: A Practical Guide

A patient’s visit to a healthcare facility is followed by his insurance verification. The provider checks the eligibility of his client before rendering services for any kind of medical issue. Insurance verification is basically a process of validating the patient’s coverage with the insurance provider. The process is technical as well as complicated. Healthcare providers need to be aware of the insurance verification process.

This blog serves as a practical guide for healthcare providers, explaining the process of patient insurance eligibility verification and providing step-by-step instructions on how to perform it effectively.

What Exactly is Patient Insurance Verification?

Patient insurance verification is the process of confirming and validating a patient’s coverage with the insurance provider. The process itself is complex and complicated. The sole purpose of this entire time-consuming process is to check the coverage and benefits provided by the health insurance company. By doing this, the healthcare provider can check the accuracy of a patient’s insurance status, coverage details, and financial responsibilities. The process involves the gathering of up-to-date information, such as

  • Patient’s insurance ID
  • Policy number
  • Co-payment Method
  • Coverage Plan
  • Deductibles requirement
  • Pre-Authorization details

Significance of Patient Insurance Verification 

Billing Errors are Minimized

Insurance verification confirms the accuracy of the billing process by validating the patient’s insurance status, coverage details, and financial responsibilities. Any kind of error in the data is detected and removed. Thus, this minimizes the chances of errors and denials in the billing process.

Do you know?

According to a recent survey conducted by the Medical Group Management Association (MGMA), billing errors result in substantial financial losses for healthcare facilities.

Claim Denials are Reduced.

A single claim denial or rejection results in a great revenue loss to the healthcare facility. The claim denial rate needs to be low as it directly affects the reimbursement process. Claim denials or rejections have a significant financial impact on the healthcare facility. Patient insurance verification prevents it to some extent, as the pre-eligibility check ensures that the provided services are aligned with the insurance coverage.

Do you know?

A recent report by the American Medical Association (AMA) reveals that in the healthcare industry, the claim denial rate is 5% to 10%.

 Revenue Cycle Management is Enhanced.

Insurance verification can effectively streamline revenue cycle management. Through a pre-eligibility check, claims are accurately submitted without any errors in the documentation. Delays in the reimbursement process are effectively reduced.

Do you know?

A survey conducted by Healthcare Financial Management Association (HFMA) highlights that  for the financial success of healthcare organizations, effective revenue cycle management is crucial.  

Address Industry Changes

The healthcare industry is evolving day by day. This change is also affecting the policies and guidelines of insurance companies. The insurance plans often undergo revisions and adaptations.Consistent insurance verification is essential for healthcare providers to stay on top of these modifications.

Do you know?

Research conducted by the Kaiser Family Foundation reveals that more than half (53%) of employees with employer-sponsored insurance altered their health plans within a span of two years.

4 Ways to Check Insurance Eligibility

4 ways to check insurance eligibilityThere are several ways to check your insurance eligibility. It ranges from online insurance portals to electronic tools. The following are some of the ways to verify insurance eligibility:

Online Insurance Portal

Many of the insurance companies facilitate healthcare providers by giving them access to their online insurance portal. Providers can log in and check the eligibility and benefits of a specific patient. These portals successfully provide real-time access to patient data and fast-forward the billing process.

EDI Transactions

EDI stands for Electronic Data Interchange (EDI). It enables a successful exchange of standardized information between the two entities, i.e., healthcare providers and insurance companies. Healthcare facilities can check eligibility electronically. Hence, the manual burden is minimized.

Interactive Voice Response (IVR) Systems

In this advanced era, insurance companies have further facilitated the healthcare industry. They offer IVR systems with automated phone services. Providers can simply call the insurance company and use the IVR system to check patient eligibility.

Integrated Electronic Health Record (EHR) Systems

Some of the healthcare organizations have integrated EHR systems. These EHRs have in-built features to verify insurance eligibility. EHRs can automatically access and retrieve patient insurance information, streamlining the verification process.

Checklist for Insurance Verification

  • Verify the patient’s full name.
  • Confirm the date of birth.
  • Check the contact information.
  • Validate the current address.
  • Collect an insurance card
  • Record the member ID.
  • Document the type of plan (HMO,PPO, etc.).
  • Call the insurance provider’s customer service for confirmation.
  • Confirm the co-pay amount for office visits.
  • Check the coinsurance percentage.
  • Verify the deductible status.
  • Verify if the patient has additional coverage (e.g., Medicaid).
 How to Verify Patient Insurance Eligibility? 

Verifying patient insurance eligibility plays a vital role in the medical billing process. Here is a step-by-step guide to how the verification process takes place. 

Step 1

Collect Patient Information

The first step is the collection of patient information. This includes the name, date of birth, address, contact number, insurance details, etc. The information must be up-to-date.

Step 2

Use Electronic Health Record (EHR) Systems

If the healthcare facility has an integrated EHR system, they utilize it. The patient’s electronic record is used to get the insurance information.

Step 3

Contact the Insurance Company

This initial contact with the insurance company is to check the eligibility of the patients. Different means, such as online portals and phone calls, are used to make this contact.

Step 4

Verify Insurance Coverage in Advance

Verification of insurance coverage before scheduling an appointment is the best step healthcare providers can take. This step ensures that patients are aware of their financial responsibilities.

Step 5

Communication with the Patient

Clear communication with the patient throughout the insurance verification process is essential. The provider needs to explain everything, such as insurance coverage, deductibles, co-payments, terms, and policies.

Step 6

Maintain an Updated Insurance Database

A regular update on the database of insurance carriers, including contact information and other required data, is a must for the providers. This directly minimizes the errors due to out-dated information.

Benefits of taking Medheave Insurance Verification

Patient insurance verification is a complex and time consuming  procedure. By hiring a reputable and reliable medical billing team at Medheave, healthcare providers can enjoy a number of benefits, such as:

Real-time Access to Data

Having free access to up-to-date insurance information is vital for the medical billing process. Outsourcing to Medheave means that providers will get the most recent and accurate insurance information. This can ultimately reduce the amount of time spent interacting with insurance providers.

Automation in the Verification Process

Automation in the insurance verification process reduces the chance of human errors. Medheave offers an automated verification process. The EHR system at Medheave allows providers to check the patient’s eligibility status as well as the insurance coverage effortlessly.

A Complete Insight into the Patient’s Insurance Status

Medheave provides a complete and thorough view of a patient’s insurance information. The company makes it easy for healthcare providers to check the insurance coverage and eligibility, policy limits, deductibles, and co-payments.

Improves Revenue Flow

An expert team at Medheave has a focus on the insurance verification process. The company ensures quicker turn-around time. With Medheave, claims are processed faster, delays in reimbursement are reduced, and cash flow is improved.


Accurate insurance verification is a fundamental step in the medical billing process. It contributes to the overall effectiveness and efficiency of revenue cycle management. Outsourcing to a reliable partner like Medheave can result in real-time access to a patient’s insurance coverage, increase the effectiveness, lower the financial burden, and improve the overall financial health of the healthcare facility. By doing this, healthcare providers can focus on their primary duty, i.e., delivering quality care. To learn more about Medheave’s patient insurance verification, call us now at (888) 487-1178.

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