Streamline Admission Process, Improve Reimbursement, and Enhance Patient Satisfaction.

At High Care, we understand that Eligibility and Benefits Verification processes are critical as it provides a clear view of insurance coverage and Patient’s responsibility to pay for the services. The absence of effective eligibility and benefits verification can lead to increased claim denials, delayed payments, additional effort on rework, delays in patient access to care and increased write-offs. To avoid this, we proactively follow up with insurance carriers for accurate and up to date information of the patient’s eligibility.

Our experienced team of professionals provides the streamlined patient’s eligibility verification process. This helps healthcare providers to know about the patient’s insurance coverage before the encounter. We assure our clients of a standardized admission process with full compliance to increase revenue and short turnaround time.

Eligibility and Benefits Verification Services:
We receive workflows from various appointment scheduling software through a range of channels including EDI, email, fax and FTP.

Accurately verify and update the primary and secondary insurance coverage details including member ID, group ID, Co-pay, co-insurance, deductible, coverage period and benefits.

Effectively communicate with payers through different possible channels to verify and update the information of In-network and Out of network benefits, PCP name matching in the patient notes. We also contact patients for additional information necessary to process the application.

We inform patients about financial responsibility for services and educate them about the payment methods.

We will notify client in case of issues regarding verification process and collaboratively work with them to immediately resolve the problem.

Benefits of our services:

• Increase Revenue and improve self-pay collections.
• Reduced patient information-related denials and rejections.
• Accurate and comprehensive patient eligibility verification.
• Improve patient satisfaction.
• Quick turnaround time.
• Assurance of data security.

Prior Authorization is one of the crucial components to ensure smooth healthcare Revenue Cycle. Managing prior authorization requires a lot of effort and valuable time that would be better spent on direct patient care. And keeping up with constantly evolving requirements of various healthcare payers can be challenging. Our highly dedicated team of experts understands the nuances and is up to date on all changes and requirements of payers, in order to reduce the Medical-necessity related denials.

Our accurate and well-organized service ensures seamless and efficient prior authorization, helping healthcare providers to attain faster reimbursement and allowing patients to get the care they need without delay.

Prior Authorization Services:

• Complete evaluation of policy and payer details to assess coverage.
• Quick analysis of each patient’s prior authorization requirements for the services.
• Promptly submit the accurate paperwork preparation to the insurance company.
• Consistently follow-up on all submitted prior authorization
  requests.
• Collaborate with payers and providers to resolve any authorization issues.

Benefits of our Services:

• Improve reimbursement.
• Reduce coverage-related denials.
• Educate the alternative choices available in coverage.
• Enhances patient awareness and satisfaction.
• Reduce A/R cycle.

A meticulous patient demographic entry process is essential to clean claim submissions and reduce denials. Inaccurate capture of patient demographic data can lead to an increased A/R cycle and delayed reimbursement. At High Care, our team of medical data entry
experts has knowledge of most practice management systems to precisely capture the patient’s demographic and coverage details. We will collaborate with providers to rectify any incomplete or erroneous information. Accurate patient information is crucial for verifying eligibility and benefits and obtaining prior authorization.

Our well-defined and checklist-based process helps to ensure high-quality Patient Demographic Entry services. Additionally, it helps to enable population health analytics.

Patient Demographic Entry Services:

We validate and enter the patient information into the practice management system after receiving it from the provider. The information includes,

• Patient’s legal name, age, gender, contact information (address, email, phone numbers, etc…)
• Social security numbers (SSN) for identification
• Primary and secondary health insurance information and policy details
• Medicare and Medicaid policy details
• Patient’s medical history
• Special requirements (Ambulance, stretcher access, interpreter, etc…)
• Guarantor name and contact information

Benefits of our services:

• High level accuracy of patient demographic entry.
• Reduce patient information-related denials.
• Improve the first-pass rates of claims.
• Maintain privacy and confidentiality of the patient data.
•  Status updates and reporting through our client portals.
• Fast turnaround time.