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  • Andrea Ryan

Electronic Insurance Eligibility Check

It has been our experience that the therapy and medical providers we have had the pleasure of working with have one very important thing in common, they get into the field because they want to make a difference for their patients. No one goes through the years of education and training required to obtain their medical license simply to make money.

There is, however, another universal truth which states that in order to keep providing services a medical practice needs to make money. In order to remain financially successful, all practices need to maintain good insurance billing practices and that all starts with establishing eligibility. In this installment of PatientStudio’s video series, lead product manager Derek Sanborn discusses the ways that an integrated patient management system can streamline the patient eligibility check and benefit verification process and improve the bottom line.


Click here to see if your payers will return electronic eligibility


Patient Eligibility and Benefits



The process of understanding a patient’s eligibility and benefits is crucial for the financial health of a practice. It is essential for providers to verify the coverage for each patient in many different ways depending on their insurance company and level of overage. Without this process, they may not be reimbursed for services rendered. You may also need to verify eligibility to ensure that your practice complies with all relevant state and federal laws.

Determining your patients’ insurance eligibility before providing care is a key part of revenue cycle management. Studies show that 75% of denied claims are because of incorrect information or lack of coverage. Taking proactive measures to ensure your patients are eligible for services will increase your clean claim rate. A check for insurance coverage before a patient’s visit can help avoid costly mistakes that could have a significant impact on your bottom line but oftentimes that is easier said than done.

Eliminate long phone calls for eligibility check

Dealing with each individual insurance company can be time consuming and tedious. With an all in one management tool like PatientStudio, eligibility checks are simple and instantaneous and most importantly completely online. Providers and office staff can stop wasting time on the phone with various insurance providers and can instead focus on the treatment of patients.

Results in real time

Office staff can quickly input an ICD-10 code for the treatment prescribed by the therapist, and within minutes (in most cases) the system will return either an approval or denial with explanation. The best part is that all of this can be done without any hold times or unnecessary conversations with representatives from the insurance company. Also, once an approval is obtained it is immediately noted in the office EHR so providers can easily know when their patients can receive a specific treatment and when they cannot. Ultimately, with a system like PatientStudio, providers and office staff can stop wasting time on the phone with various insurance providers and can instead focus on the treatment of patients.

Though it is not why anyone goes into therapy or medicine, insurance eligibility checks are essential to maintaining a healthy practice and a solid bottom line. If you are curious about whether or not your payers are currently supported by PatientStudio, please fill out this form and we can let you know.