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Verifying Health Insurance Enrollment

January 2016

CRE TA Center

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Tips for verifying client health insurance enrollment to improve your charge-to-collection ratio. Use health insurers’ electronic eligibility verification systems before scheduled visits to identify termination of enrollment or other changes. Then contact the patient before the visit to identify new insurers and request the patient to bring in their new insurance cards. Insurance enrollment should also be checked at the beginning of the calendar year, as many patients have new insurance plans, co-pays, and deductibles. Key steps before and during the client visit include:

Before the Visit

  • Ask the client about changes in insurance when the appointment is made. Ensure that your staff know in which plans your agency participates.
  • Use your EHR or billing software to check enrollment, deductibles, and co-payments at least one day before the visit.

During the Visit

  • Confirm the insurance to be billed.
  • Obtain a copy of insurance card.
  • Inform the client of co-pay requirements.

Part of Collection

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