VerdureRCM

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Human-centered AI in Healthcare

Eligibility and Benefits Verification

Optimize Your Revenue Cycle with Proactive and Accurate Eligibility Verification
Eligibility and Benefits Verification
In the healthcare revenue cycle, insurance and benefits verification is a pivotal step that directly impacts claim approval rates, cash flow, and patient satisfaction. Inaccurate or incomplete insurance verification can result in costly downstream errors, delayed payments, and increased patient dissatisfaction due to unexpected bills. Validating a patient’s insurance coverage and benefits at the outset of care minimizes claim denials, expedites reimbursement, and streamlines administrative processes for both providers and patients.

A comprehensive, real-time insurance and benefits validation system as well as an understanding of the patient’s liability for every visit, empowers healthcare organizations to confirm coverage and eligibility upfront, drastically reducing claim denials by up to 50% and improving the overall financial performance of the revenue cycle.

Challenges in Eligibility and
Benefits Verification

Denied Claims

Insurance claims are often denied due to outdated or incorrect patient insurance information and benefit checks.

Revenue Leakage

Failure to verify insurance details and perform benefit checks upfront leads to uncollected payments and increased bad debt.

Manual Processes

Manually checking eligibility and coverage across multiple payers can slow down operations, resulting in delayed payments.

Patient Experience

Patients face unexpected medical bills if benefits are misunderstood or misrepresented during the verification process.
Our Solution : Comprehensive Insurance and Benefits Validation

Our Insurance and Benefits Validation solution automates and simplifies the verification process, ensuring accuracy and compliance at every step. With real-time connectivity to 1000’s of insurance payers and a user-friendly interface, our system validates patient coverage, co-pays, deductibles, service eligibility upfront – and provides an estimate of liability for the patient for every visit, even before the appointment

Key Features

Real-Time Verification

Instantly confirm patient coverage and benefit details with all major payers.

Automation

Automatically verify eligibility during patient registration and prior to service delivery.

Comprehensive Coverage

Validate insurance for Medicare, Medicaid, commercial and private payers.

Integration

Seamlessly integrate with existing Electronic Health Record (EHR) and Practice Management (PM) .

Compliance

Stay compliant with healthcare regulations such as the Surprise Billing Prevention Act.

Liability Estimator

Get a clear up to date understanding of the patient’s liability for every appointment.

Key Benefits

Boost Revenue

By reducing denials and uncollected payments, your organization can significantly improve its financial health.

Enhance Patient Satisfaction

Increase patient satisfaction by up to 20% by speedy and accurate eligibility and benefits verification.

Reduce Denials

Reduce denials related to eligibility and benefits verification by up to 50%.

Improve Operational Efficiency

Eliminate manual work, freeing up staff to focus on more critical tasks.

Accelerate Payments

Quicker and more accurate verification reduces delays in reimbursement and accelerates cash flow.

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