Patient Benefits Verification

This Job Aid outline the process to follow by a Patient’s Benefits Coordinator (PBC) when doing Patient Benefits Verifications for the practice Josh Amyx / IMAC Regeneration.

Overview

The PBC’s main responsibility is to verify patient’s insurance benefits. The practice’s staff uploads the forms into the Kareo Desktop Application for the PBC to download the forms, verifies the patient’s insurance benefits, complete the form, and upload it back into the desktop application.  

The PBC must fill every field on the form, even if not applicable or not covered. When this is the case, the PBC should notate the field with the right term. For example, If there is no preferred VISCO, specify that on the respective field or if there is not need for an authorization/precertification, that should be stated on the form as well.

1) New Verification

1. Front Desk staff has a blank form, when a new patient appointment is scheduled, the practice will fill out the basic patient information and add the first appointment date to the form for the corresponding location.  If there are any special needs or circumstances, this needs to be notated in this form.

2. This document will then be saved with the following document name “Patient Name.VERIFY” and uploaded into documents as follows, click File, and choose the form to be verified.

   Document Label: Eligibility

   Status: New (make sure to change the status to New, it will default as Processed).

3. The PBC will pull all NEW Eligibility documents twice per day and verify benefits based on information on the form with any additional requests added.
4. Once completed, the PBC will upload the form with the same format “Patient Name.COMPLETE” into the patient’s account documents.
   Document Label: Eligibility
   Status: Ready for Entry.

5. Office Staff will download the completed form the patient’s account, specifically in the patient’s documents.  Once the office has pulled the completed benefits, will change status to PROCESSED.

6. All communications or notes are to be added in the patient accounts (notes section)

7. If the patient requires prior authorization, add an alert to the patients account indicating: “AUTHORIZATION REQUIRED - CHECK BENEFITS FORM”

2) Reporting

The PBC must fill daily a report, for visibility and to be accountable for the completed requests.  You can find the report here:

https://hpi365.sharepoint.com/:x:/s/PMB.CR/ERQ_d1OZvTRNgtDVD47KNsYBHN6ephsAdlWn7q2S6v3BlA?e=hsCEwd

Every new entry must have the following details:

• Office Name

• Patient Name

• Patient Date of Birth

• Insurance Name: Make sure to group the patients per Insurance when possible. We need to try to obtain info from as many patients as possible on the same call

• Received Date

• Completed Date (once the form is completed)

• Appointment Date: this is how we prioritize the incoming requests

• Notes (only when needed, notes are not a mandatory)

• DOC ID of the completed form

• Completed by: The PBC initials

• Status: Completed o Incomplete (when the appt date is due and the PBC was unable complete the form)

3) Special Request

1. Incoming requests with no appointment dates or appointment dates with less than 24 hours to complete, will be completed within the next 72 business hours.

2. If the PBC cannot complete the form before the appointment date for any given reason, will still upload the incomplete form and we commit to complete the form within the next 24 business hours.