The Insurance Verification List is useful for offices that verify Insurance Benefits and patient eligibility prior to appointments. Use it to quickly identify when insurance benefits and patient eligibility needs verification. You can also assign ownership of verifications, then track, change, and manage verification status. Set defaults for the list in Insurance Verification Setup.
- In the Appointments Module, click the Appointment Lists icon in the upper right above the calendar.
- Click Ins Verify.
The Verification List tab will be highlighted by default. Verifications are grouped by those that are current and those that are past due. Click a tab to view verifications that meet the criteria.
- Current: Verifications for appointments in the future that meet the filter criteria.
- Past Due: Verifications that meet filter criteria, yet are past due. Typically this list should only include verifications for yesterday's appointments that need to be done as soon as possible. The number of days that determine past due status is set in Insurance Verification Setup (default = 1).
Three types of verifications (Type) may list:
- Pat: Patient eligibility needs verification.
- Ins: Insurance benefits needs verification.
- Ins/Pat: Both patient eligibility and insurance benefits need verification.
Click on a column header to sort the list in ascending or descending order. To preview insurance plan information, subscriber information, and verification status, highlight a patient or plan. The info will appear at the bottom. To open the Edit Insurance Plan Window, double click a row, or right click and click Go to Patient Plan.
Note: To change information, the Insurance Plan Edit security permission is required.
Verification Filters: If needed, change the criteria to change the results. Set defaults in Insurance Verification Setup.
- Days until scheduled appointment: The default is 7. Example: patients with scheduled appointments in the next 7 days will list.
- Plan benefits haven't been verified in: Determines which insurance plans (Ins) list based on the last benefit verification date. The default is 90 days.
- Days since patient enrollment: Determines which patients (Pat) list based on the last patient eligibility verification date. The default is 30 days.
- Carrier: Enter a specific carrier name. Blank = all carriers.
- For User: List verifications assigned to a specific user. The dropdown will list all users currently assigned a verification. Click to select, or click [...] to select from a pick list. Select All = All Users. Select None = Unassigned.
- Verify Status: Only list plans and patients with a specific verification status. Customize options in Definitions: Insurance Verification Status.
- Region (only visible when using Clinics): List verifications by clinic region. The options can be customized in Definitions: Regions.
- Clinic (only visible when using Clinics): List patients with appointments in a specific clinic. Only clinics accessible by the logged-on user are options.
- 01/01/0001 will be the initial last verified date for all plans and patients.
- To exclude a plan from the list, check Don't Verify on the Edit Insurance Plan window.
Mark a Patient Eligibility (Pat) and/or Insurance Benefits (Ins) as Verified
There are several ways to mark patient eligibility and/or insurance benefits as verified. Marking a verification as verified will change last verified dates on the Edit Insurance Plan window.
- On the Verification List tab, right click on a verification then select an option. Options will vary depending on the type of verification selected.
Verify Patient Eligibility: Mark patient eligibility as verified (change the Eligibility Last Verified date to today).
Verify Insurance Plan: Mark insurance benefits as verified (change the Benefits Last Verified date to today).
Verify Both: Mark both patient eligibility and insurance benefits as verified (change both dates today).
A confirmation message will show.
- Click OK.
- On the Verification List tab, highlight the verification row. General insurance plan and subscriber information will show in the bottom of the window.
- Click one of the verified buttons:
- Mark Patient Eligibility Verified: Mark patient eligibility as verified (change the Eligibility Last Verified date to today).
- Mark Ins Benefits Verified: Mark insurance benefits as verified (change the Benefits Last Verified date to today).
- A confirmation message will show. Click OK to confirm.
- On the Verification List tab, double click a verification row, or right click and select Go To Plan to open the Edit Insurance Plan window.
- To verify patient eligibility, enter a value for Eligibility Last Verified.
- To verify insurance plan benefits, enter a value for Benefits Last Verified.
- Click OK to save.
Change Verification Status
Verification status is a way to track insurance verification progress. Status options are defined in Definitions, Insurance Verification Status. When you change a status, the status date will update to reflect the date of the change.
- On the Verification List tab or Assign Verification tab, right click on a patient or plan, select Set Verify Status to, then select the option.
- (optional) Enter a note.
- Click OK.
- On the Verification List tab, highlight the patient or plan. The insurance plan, subscriber, and status will show at the bottom of the window.
- Click the Verify Status dropdown and select an option.
- (optional) Enter a note.
- Click OK.
Assign Ownership of Verifications
This tool is useful for delegating responsibility for verifications to specific users. Multiple plans and patients can be assigned at once. To be assigned a verification, a user must have the Insurance Plan Verification List security permission.
Option 1: On the Verification List tab, right click on a verification, click Assign to User, then select the user.
Option 2: Useful when assigning many verifications at once.
- Click the Assign Verification tab.
By default, Unassigned verifications list (For User).
- Highlight the verifications to assign. To select many, click and drag, or press Ctrl or Shift while clicking.
- Right click anywhere on a highlighted verification, select Assign to User, then select the user, or, under Assign Verification, click [...] next to To User.
Double click the user to select, then click Assign. Select None = Unassigned.