Why you should be using our new Eligibility Tool?

Why you should be using our new Eligibility Tool?


Eligibility verification of a patient’s insurance coverage is a seemingly small task in the workflow of a front-desk person, but it’s the lynchpin in the office’s finances and cash flow. Why? Verifying a patient’s eligibility ensures you receive proper payment from them while reducing claim denials from payers.

According to RevCycle Intelligence, an online publication focusing on healthcare revenue cycles and other medical economic issues, nearly 10% of claims are rejected by payers because of eligibility issues – making eligibility one of the leading causes for claims denial.  And reworking denials is an expensive proposition. MGMA notes that practices spend $25 to rework each declined claim.

The good news is that most offices are verifying eligibility. RevCycle Intelligence points to the fact that almost 80% of offices say they check eligibility on the initial visit. That percentage drops dramatically for subsequent visits when only 25% of eligibility checks are done.  Part of the reluctance to verify coverage may be the time associated with manually doing it. According to MGMA, over 12 minutes are spent per patient manually verifying eligibility.  On average, that equals 8 hours each week – one total workday
– doing nothing but manually checking eligibility.

It’s also expensive. CAQH estimates that manually verifying eligibility for 1,250 patients in a year – equal to just a few patients a day – costs a practice over $6,000.

But eligibility doesn’t need to be time consuming or expensive. Electronic verification reduces the time required to check eligibility, simplifies workflow, and can increase cash flow by reducing denied claims. It’s also far less expensive than manual verification. According to CAQH, electronic eligibility verification costs practices around $1,000 annually – a fraction of manual verification.

UHIN offers an electronic verification tool intended to allow medical offices the ability to request their patients’ eligibility and benefits prior to their appointment. It also ensures claims are submitted with the correct contract number on the first submission, saving time and decreasing the payment cycle time. All important factors in helping prevent cash flow issues.

Additionally, requesting eligibility at the time the appointment is scheduled can help you and your patient understand the potential out-of-pocket responsibility. Conducting another eligibility verification the day prior to the appointment will help ensure the information has remained the same and, if not, allow you the opportunity to obtain the correct payer information.  If the original eligibility is verified, you’ll have the opportunity to work with the patient on any out-of-pocket balances they may owe.

The UHIN electronic eligibility tool is a convenient and cost-effective solution to help practices save money while improving claim acceptance and eliminating payment delays. It now has an enhanced Patient Snapshot found in a dual pane screen – conveniently allowing you to view important patient information without needing to scroll down the page. Subscriber, plan, and co-pay information are also easily accessible.

Not using the Eligibility Tool?  Contact customerservice@uhin.org for more information!