Eligibility and Benefits Verification

At Operant Billing Solutions we’ve found that the overall success or failure of a single patient claims process starts with the patient intake process. This is often related to the patient’s insurance eligibility or insurance verification. This means that things like patient pre-registration are just as important as the end billing process, if not more important.

Even the smallest errors or uncollected information during the patient intake process can complicate the billing process, as well as increase the risk of a denied claim. Having a professional administrative service like Operant Billing Solutions handle patient eligibility and benefit verification not only frees you up to focus on treating patients, we can also help identify other potential problems like:

  • Details of coinsurance or copay requirements

  • Deductible limits

  • Potential benefits caps

  • Identifying where to send a pertinent claim

  • Determining if the payer is required to fill out specialized forms

  • Filing additional document requests

  • Updating medical history and providing the necessary paperwork 

Once our staff receives the eligibility request with copies of both sides of the patient’s insurance card, the representative can disseminate the information to the eligibility department and coordinate with the insurance provider. The underlying goal is to obtain as much information about the patient’s benefits as possible. All the while keeping a watchful eye for conflicting information that could complicate the RCM process later on.

After eligibility has been confirmed, Operant Billing Solutions representatives will send you an eligibility response. This will include all the pertinent information we obtained from the patient or payer as well as their insurance provider. The turnaround time for this documentation is typically 2 to 5 business days. Though some insurance carriers take longer than others. Regardless, our fast, efficient practices are designed to determine eligibility and communicate it at industry-leading speeds.

Professionally Administered Authorization Services

Operant Billing Solutions’ experienced staff can help with every aspect of the pre-registration and the pre-certification process. This frees you and your clinical staff to focus on treating qualified patients, as well as other important aspects of securing your practice’s success. This level of administrative outsourcing is quickly becoming the new normal throughout the healthcare and mental health industry.

For many healthcare providers the pre-authorization process can be frustrating and increases the risk of administrative workflow interruption and other RCM problems. Not the least of which is the risk for a claim to be denied, after treatment, by the insurance provider.

Operant Billing Solutions’ pre-authorization services are designed to facilitate the pre-certification process coordinating seamlessly with healthcare providers as well as the patient payers. Pre-authorization services are often a necessary first step in most therapy services or any procedure that requires a pre-certification.

Our administrative professionals use a state-of-the-art pre-certification portal infrastructure to accurately collect patient information as well as information from all related medical providers to outline all necessary procedures.

Operant Billing Solutions handles the pre-certification process from a central location. This further helps to maximize the rate of claim reimbursements while also helping to reduce common problems like accidental record duplication and simple patient data errors. We have experienced customer service staff to navigate any eligibility concerns.

Our administrative professionals can then communicate all the pertinent information to your practice’s office staff as well as the insurance payers. This helps to ensure pre-certification and approval requirements without any unnecessary delays.

Benefits Of Operant Billing Solutions Eligibility Verification

At Operant Billing Solutions we are dedicated to helping all our clients successfully manage their administrative requirements. While we often work with behavioral therapists we also have a wide range of other clients.

This includes Board Certified Behavior Analysts, Speech-Language Pathologists, Occupational Therapists, Physical Therapists, Mental Health Providers, other Medical Professionals.

These services and more help to free up your in-house resources, and staff to work on other more important aspects of the practice.

  • Information being transmitted via a secure web-based portal

  • Confirmation of insurance pre-certification

  • A simplified, single management system

  • Patient tracking

  • Address validation

  • Notifications of benefits verification

  • Weekly status updates

  • Rapid turnaround time and increased customer satisfaction