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What Are the Steps in Medical Insurance Verification?

What Are the Steps in Medical Insurance Verification?

Timely settlement of claims is the key to efficient revenue cycle management for any healthcare practitioner. Ideally, patients provide their coverage details before the visit to the practitioner. Next, the practitioner’s administrative staff updates the patient coverage information in their records. However, often there are shortcomings in these processes, which leads to delays or denials in the settlement of insurance claims. Insurance eligibility verification can reduce denials and increase the efficiency of medical billing. 

Here are the key steps involved in medical insurance verification:

  • Thorough checking of documents:

Insurance companies outline a list of documents required to process a claim. For example, certain treatments may require a pre-authorization from the insurer before visiting a practitioner. Insurance eligibility verification involves thoroughly checking the documents received from healthcare organizations. Subsequently, insurance verifiers match these documents against a checklist of documents required by insurers.

  • Verification of patient’s coverage:

As the next step, insurance eligibility verification involves checking the coverage of patients. For example, at a basic level, they will check whether a patient’s plan is active or not. It also covers checking the type of insurance. For example, an HMO plan provides maximum insurance coverage within a network of hospitals covered under the plan. In comparison, a PPO plan allows patients to choose from a wide network of doctors and hospitals. Verification also covers checking the remaining amount of deductible and out of pocket expenses. This process is largely done online using the information available on insurance portals.

  • Matching self-pay patients and reducing their burden:

Most patients are unaware of the details of their coverage. This problem is particularly true for self-pay patients, who may assume they have to pay for everything from their pocket. If they are going through financial difficulties, this may deter them from taking the necessary treatment. However, professional insurance eligibility verification services help match the records of self-pay patients with electronic healthcare databases. This process can help provide useful coverage information to self-pay patients, which they may not be aware of. Accurate verification reduces the financial worries of the patients and creates additional revenue opportunities for healthcare practitioners.

  • Following up with patients:

At times, certain information about a patient’s coverage may not be available online. Insurance eligibility verification extends to calling patients and seeking the information needed from them in person in such scenarios. The final check helps in ensuring there are no gaps in the information required by insurers.

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  • Submission of verified information:

Once all the information has been verified, it is submitted to the healthcare practitioner. It includes all the key details, including the patient’s eligibility and information on deductibles, copay, and coinsurance, to give the practitioner a clear picture.


To conclude, medical insurance verification can increase the speed of claims processing and reduce denials. Lower denials help practitioners in better cash flow management and help improve the satisfaction of patients.


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