At Zephyr Health Management Service, we recognize the importance of thorough eligibility and benefits verification processes for healthcare providers. Our services ensure that providers receive accurate, timely, and comprehensive information about a patient’s insurance coverage, facilitating informed decisions about care, medications, and diagnostics, especially for elective and non-emergency procedures.

Proper checks in this process are essential to avoid revenue losses due to denials and delayed payments. We provide upfront insights into a patient’s eligibility before the encounter, enabling providers to suggest treatments aligned with coverage, understand out-of-network benefits, and determine payment obligations.

Our Services Include:

• Flexible Workflow Channels: We accommodate various patient scheduling systems, including EDI, Fax, emails, and FTP files.
• Fast and Accurate Verification: We verify primary and secondary coverage details, such as member ID, group ID, coverage period, co-pay, deductible, and co-insurance information.
• Efficient Payer Connections: We use the best possible channels to connect with payers.
• Data Validation: We promptly identify and resolve missing or invalid data.
• Robotic Process Automation: This enhances speed and accuracy in our verification processes.
• Comprehensive Verification: We verify patient demographics, policy information, benefits, deductibles, and plan inclusions/exclusions.
• Pre-Certification and Approval: We obtain pre-certification numbers and approval for benefits verification.
• Revenue Cycle Management Updates: We verify and update coverage, co-pays, co-insurance, deductibles, and claims mailing addresses for all primary and secondary payers.

Value Proposition:

Our Eligibility Verification Services offer significant benefits:

• Optimized Revenue and Cash Flow: Ensuring accurate information reduces denials and payment delays.
• Reduced Denials: Accurate patient information minimizes denials related to data issues.
• Cost Savings: Our global delivery model ensures cost efficiency.
• Data Accuracy and Completeness: We ensure that all data is accurate and complete.
• Upfront Clarification: Clear communication of patient responsibilities improves satisfaction.
• Enhanced Patient Satisfaction: Accurate eligibility information enhances the overall patient experience.
• Improved Quality: Our services lead to fewer information-related rejections.

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Learn how Zephyr Health Management Service’s Eligibility and Benefits Verification Services can support your organization.