Clever Strategies to Verify Patient Eligibility and Reduce Claim Rejections

Every optometry provider must verify a patient's insurance eligibility and benefits in order to get maximum reimbursements for their services. Eligibility verification plays a critical role in identifying the amount a patient may owe to the provider. Providing effective cost estimates not only reduces future denied claims for your optometry practice but also helps in boosting patient satisfaction.

Looking for smart optometry billing practices to bring claim denials and rejections down to a minimum? Have a look at these effective tips to enhance your operations and streamline patient eligibility and benefits verification for your optometry insurance. This helps in keeping your claims clean and minimizing any possibilities of claims rejections or denials.



Verifying Authenticity of Insurance Data


Every optometry service provider must ensure the insurance eligibility of a patient before providing services. This helps in avoiding claim denial possibilities. To verify patient's insurance eligibility, providers must collect details including:

  • Insurer's or patient’s full name with correct spellings

  • Relationship between patient and verified insurer

  • Patient's correct date of birth

  • Correct insurance billing address

  • Insurer/ patient number


Make sure that you verify the patient's insurance and policy details with the concerned insurance payer. Collecting accurate insurance data is a prerequisite for streamlined claims processing. It ensures that you do not lose out on any revenue due to optometry claim rejections.



Confirm Whether Insurance Coverage Plan is Active


Make sure you check the patient’s insurance card while they book an appointment with you to confirm you have the correct insurance plan listed. Evaluate the patient's eligibility at least 5–7 days before the patient’s initial visit. Confirm if the insurance plan policy coverage is effective by getting in touch with the insurance payer. If the patient does not have insurance coverage, let them know about the amount they will need to pay for the service.



Get Authorized to Provide Specific Optometry Services


It is important to gain prior authorization from insurance payers for certain service offerings in order to start claiming optometry billing reimbursements for those services. A payer that authorizes a service also assigns an authorization number. This number is important as it is included in every claim submitted for that specific service. Ensuring that this number is accurate will help you to reduce claim denials and maintain a positive revenue flow in your optometric practice.



Be Upfront About Patients’ Financial Obligations


If a patient doesn’t have insurance coverage, it is essential for providers to inform them about their financial obligations. Also, if you suspect that a specific service is not covered, get an Advance Beneficiary Notice of Noncoverage from the patients before proceeding with the treatment. Similarly, you should also verify the patient's extra insurance costs like co-pays, co-insurance, and deductibles to let them know about these payments beforehand.


At CSEye, we help you effectively verify patient eligibility and benefits for eye care insurance to maximize the cash flow for your optometry practice. Our denial management service can assist your billing staff to reduce claims rejections and improve your reimbursement rates significantly. Contact us to know how CS Eye can help you get paid accurately for the services you provide.


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