Eligibility Verification: Thoughtful’s Seamless Solution for Keeping Up with Eligibility

Eligibility discrepancies are a common headache in healthcare revenue cycle management (RCM), leading to frustrating claim denials and increasing lost revenue. But with Eligibility Verification, patient providers can finally catch these discrepancies before they cause problems.

What is Eligibility Verification?

Eligibility Verification is a seamless AI-powered solution 95% faster than a human team, catching eligibility changes before they become claim denials. With a 20% decrease in denials with Eligibility Verification, you save time and money while improving patient care.

Eligibility Verification For Medicaid Eligibility Checks

Regarding Medicaid eligibility checks, healthcare providers often face complex and
ever-changing eligibility requirements. Because of ever changing regulations, patient providers need to run eligibility checks for every patient, every time to avoid claims.

Missing or inaccurate Medicaid eligibility information can significantly impact revenue cycles. Eligibility discrepancies can lead to claim denials, delayed payments, and costly legal disputes. In some cases, providers may provide services to patients who are not eligible for Medicaid, resulting in uncompensated care costs that can strain their finances.

To address these challenges, healthcare providers need a reliable solution for Medicaid eligibility checks. This is where Eligibility Verification comes in.

Eligibility Verification provides complete and up-to-date Medicaid eligibility details, allowing healthcare providers to accurately verify eligibility before providing services. Providers can be reassured about missing important information or eligibility changes that could impact their revenue cycle. And critically, Verified can perform automated, regular Medicaid eligibility checks, freeing providers of discrepancies that arise from periodic and untimely checks.

Eligibility Verification also handles all nuances across various Medicaid providers, accommodating any exception workflows that may arise. In other words, it works for everyone, no matter the workflow quirks inherent in your systems.

Eligibility Verification For Commercial Payor Checks

One of the biggest challenges for healthcare providers is keeping up with the constantly changing eligibility rules across various commercial payors. These changes can occur frequently, making it difficult for providers to track them all. Enter Eligibility Verification.

With a dynamic rules engine that’s seamless to update, Eligibility Verification can keep up with changing eligibility rules across payors. It can even initiate communication with the payor or provider to resolve unexpected changes in eligibility status.

For example, if a patient’s commercial payor changes their eligibility rules mid-year, Eligibility Verification will quickly adapt, verifying eligibility before patient visits.

Eligibility Verification Benefits

Collect more money faster.

Thoughtful's Eligibility Verification product provides a seamless eligibility verification process, which can help reduce claim denials and ensure that billing is done correctly. By catching any eligibility discrepancies before delivering services, healthcare providers can experience faster payment turnaround times and higher revenue. This is especially important in today's healthcare industry, where profit margins are increasingly tight.

Higher capacity, less headcount.

With Eligibility Verification's automation and dynamic rules engine, healthcare providers can handle more eligibility checks quickly, freeing up staff to focus on other essential tasks. Providers can increase their capacity to serve more patients without hiring additional staff.

Acquire and retain more patients.

Providers must stand out and attract new patients in today's competitive healthcare industry. One way to do this is by providing a seamless eligibility verification process that prioritizes convenience and efficiency. By reducing the hassle of eligibility verification, providers can attract and retain more patients, leading to increased revenue and a more stable business. In addition, by prioritizing patient satisfaction, providers can build a positive reputation in their community and gain a competitive edge.

Don't let your revenue cycle slow down eligibility discrepancies with commercial payors and Medicaid. Instead, try Eligibility Verification today and experience the benefits of seamless and efficient eligibility verification.

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Published On:

July 19, 2023

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