In the ever-evolving landscape of healthcare, technology continues to reshape various aspects of patient care and administrative processes. As per the report, the global robotic process automation in healthcare market is expected to hit around USD 14.18 billion by 2032 with a registered CAGR of 26.1% from 2023 to 2032. In our earlier blog, we discussed the Electronic health record management and how automation can simplify it.
In this blog, we will explore how insurance eligibility verification and benefits checks are important processes in the healthcare revenue cycle once a patient schedules an appointment. So let’s explore more about patient insurance eligibility verification and how automation can fast-track the verification process for healthcare providers.
Patient insurance eligibility verification ensures a patient’s insurance is active and covers the required treatment before care is provided. Automation streamlines this process, reduces errors, accelerates reimbursements, and improves the patient experience—all within minutes instead of hours.
What is Patient Insurance Eligibility Verification?
Patient insurance eligibility verification is the process of confirming a patient’s active insurance coverage and understanding policy details such as coverage limits, exclusions, and prerequisites before medical services are delivered. Automation can reduce manual verification from hours to seconds.
It involves the process of confirming whether a patient possesses valid and active insurance coverage at the point when they require medical attention. Moreover, this process extends to verifying the intricate details of their insurance policy.
In addition, it is important to understand what treatments are covered by the policy, what limitations exist, and what exceptions or prerequisites must be met before the insurance company assumes responsibility for a particular medical service. This process involves four steps that must be performed by healthcare providers to complete the process and these steps are-
- Collect patient insurance details: Gather information such as ID, date of birth (DOB), and policy number.
- Verify eligibility: Confirm the patient’s coverage directly with the insurance provider.
- Check coverage specifics: Review covered treatments, limits, exclusions, and prerequisites.
- Record verified data: Update the patient’s information in the EHR or billing system for seamless processing.
Results of Incorrect or Delayed Verification of Insurance Eligibility
Failure to perform precise and prompt insurance eligibility verification can lead to various challenges for healthcare providers.
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Delayed Reimbursements
healthcare providers do not verify a patient’s insurance coverage promptly and accurately, there’s a risk that the services provided may not be covered by the patient’s insurance policy. This could result in the provider submitting a claim to the insurance company, only to have it rejected. As a result, the reimbursement for the services rendered would be postponed. Providers might need to pursue payment directly from the patient or absorb the costs themselves.
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Claim Rejections
In cases where insurance coverage isn’t adequately verified, healthcare providers might offer services that are not covered by the patient’s insurance plan. Consequently, when the provider submits a claim to the insurance company for these services, the claim could be turned down entirely. This leaves the provider without compensation for the services they’ve delivered.
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Operational Inefficiencies
Addressing each denied claim necessitates extra administrative work, whether it entails pursuing payment from the patient or absorbing the cost. This added administrative burden contributes to operational inefficiencies and increased operational costs.
Automated insurance eligibility verification processes reduce queue time and improve customer experience. This also enables front desk staff to have more time at hand to work on patient queries. Most importantly, it ensures the accuracy of patient and insurer information while onboarding new patient referrals.
Manual vs Automated Insurance Eligibility Verification
Verifying insurance manually can be time-consuming, error-prone, and costly. Automation transforms this process, making it faster, more accurate, and efficient.
The comparison below highlights the key differences between manual and automated insurance eligibility verification:
| Issue | Manual Process Impact | Automated Process Benefit |
|---|---|---|
| Delayed Reimbursements | Weeks to get paid | Seconds to verify, instant updates |
| Claim Rejections | High denial rate | Reduced errors and denials |
| Operational Inefficiency | Extra admin work | Streamlined workflow, saves time |
AutomationEdge to Streamline Patient Insurance Eligibility Verification Process
Insurance eligibility verification is a multi-step process that requires multiple logins to disparate systems of record to verify information given by a single patient. When done manually, this process could consume numerous hours within a week, significantly impeding prompt patient care.
AutomationEdge’s AI solution comes with intelligent document processing capabilities that can address the insurance eligibility verification challenges and help healthcare providers. It eliminates the necessity of navigating various record systems to initiate timely care and ensure accurate reimbursements. Using AutomationEdge’s AI bot enterprises can-
- Read the patient insurance information using OCR, and Machine Learning(ML) like member ID and Date of Birth from the scanned card
- Check the insurance eligibility on the insurance portal using automation
- Update the information in EHR systems and share the status
Benefits of Automating Patient Insurance Eligibility Verification
Once patient insurance details are verified accurately and quickly through automation, healthcare providers experience several immediate advantages.
Automation not only saves time but also ensures a smoother workflow, reduces errors, and enhances the overall patient experience.
- Faster Reimbursements: Reduce claim delays and improve cash flow.
- Higher Accuracy: Eliminate human errors in patient insurance data.
- Operational Efficiency: Free staff from repetitive verification tasks.
- Better Patient Experience: Reduce waiting times and administrative hassles.
- Regulatory Compliance: Ensure accurate documentation for audits.
Emerging Trends in Automated Insurance Verification
As healthcare providers increasingly adopt automation, keeping up with the latest automated insurance verification trends is essential for improving efficiency and patient care.
Leveraging cutting-edge technologies in AI in healthcare and RPA in patient insurance checks can reduce errors, accelerate reimbursements, and streamline workflows.
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AI-Powered Predictive Verification:
Advanced AI models can predict potential claim denials before submission, enabling proactive resolution and minimizing delays in payment.
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Real-Time Eligibility Checks:
Automated eligibility verification through API integrations allows instant checks, cutting down administrative workload and improving accuracy.
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Integration with EHR & Telehealth Platforms:
RPA in patient insurance checks ensures seamless updates in electronic health records and telehealth systems, supporting efficient patient onboarding and care coordination.
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Blockchain for Insurance Verification:
Using blockchain technology makes insurance data secure, immutable, and fully auditable, reinforcing compliance and patient trust.
Conclusion
Automating the process of verifying patient insurance eligibility holds a multitude of advantages for healthcare providers. These encompass heightened precision, streamlined efficiency, reduced expenses, and elevated patient contentment.
By leveraging AI-powered solutions like AutomationEdge, providers can accelerate reimbursements, minimize claim denials, and ensure accurate coverage verification in real time.
Despite potential obstacles, the integration of automated verification stands as a judicious approach for healthcare providers striving to update their practices and amplify their fiscal viability. As technological progress persists, we can envisage additional refinements in automated verification systems, thereby amplifying their efficiency, precision, and security.