Eligibility Verification and Prior Authorization Services from Access Healthcare

Eligibility and benefit verification is vital to ensuring accurate and timely receipt of information regarding insurance coverage, and determining the patient’s responsibility to pay for healthcare services. Even then, many healthcare providers do not pay the needed attention to eligibility and benefits verification process. Accurate and timely determination of the patient’s eligibility provides healthcare providers a clear view on patient’s coverage, out-of-network benefits. and accurate insurance information. Incorrect insurance information could result in delayed payment at best, or denial at worst.

Performing eligibility verification helps healthcare providers submit clean claims. It avoids claim resubmission, reduce demographic or eligibility related rejections and denials, increase upfront collections; leading to improved patient satisfaction. Also, verifying authorization requirement before the service avoids denials, and contributes to increase in collections. Leverage Access Healthcare’s Eligibility Verification and Prior Authorization services to optimize your revenue cycle and improve collections.

Eligibility and Benefits Verification Services

  • We receive our workflow through the patient scheduling system, EDI, Fax, emails, and FTP files

  • We verify primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible / co-insurance information, and benefit information

  • We use the best channel (call or web) to connect with the payer

  • We perform automated eligibility verification using our RPA tools

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Prior Authorization

Access Healthcare's prior authorization team is adept at:

  • Determining prior authorization requirements

  • Preparing and submitting requisite information to the payer

  • Following up on submitted prior-authorization requests

  • Notifying the providers in case any authorization issues are identified

Access Healthcare’s Value Proposition for Eligibility Verification and prior authorization services

  • Optimize cash flow

  • Reduce patient related denials

  • Avoid rejection of claims by payers due to inaccurate or incomplete information

  • Identify the patient’s responsibility upfront

  • Improve patient satisfaction

  • Process Automation solutions


Contact us to learn more about Access Healthcare's Eligibility Verification and Prior authorization Services

Global collaboration is key

Outsourcing a part of your business in any way, especially offshore, can be a very scary decision. Access Healthcare’s best practices engine and arc.in platform give you peace of mind and complete transparency into the process.