SUCCESS
STORIES

Eligibility and Benefit Verification - Dental

Background:

The client is a leading Dental Practice Management Company that outsourced its Eligibility and Benefits breakdown verification of patients who are due to visit clinics in next 3 days, to Medusind. This client, with more than 50 clinics, had asked Medusind to verify eligibility and benefits calling insurance carriers, using web portals, AVR, and rosters for HMO patients.

Key Challenges:

• Verifying eligibility for patient before they walk-in for their appointment.
• To cross verify and update benefit breakdown correctly.
• To verify and update Orthodontic benefits breakdown correctly.

The Medusind Approach & Solution:

• Identified the key areas to fix front-end related issues.
• Focused on the key issues that resulted in accurately verifying eligibility and benefit breakdown for all patients.
• Regular reporting to Client with value added statistical analysis.

Benefits to Client:

• Cleaned up patient and insurance database leading to transmission of clean claims.
• Due to correct eligibility and benefits breakdown verification, percentage of clean claims submitted to carriers increased significantly.
• With more clean claims being submitted, the timely filing limit is minimized, resulting in increased cash flow.
• Subscription to online payer services resulted in timely verification of patient demographics and eligibility status.

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