Electronic Benefit Verification: Electronically Verify Patient Insurance
You can electronically verify benefits using the Electronic Benefit Verification (eBV) product for a patient after you map the patient's insurance. You must have View Patient and Edit Patient User permissions to use this process. Click here for the full Electronic Benefit Verification overview.
IN THIS ARTICLE
Verify Patient Insurance
- You'll need to review and ensure the patient insurance is mapped to the Electronic Verified Payer, click Patient Info from the patient’s chart.
From the Insurance tab, review the Mapped column to determine if the patient insurance is mapped to the Electronic Verified Payer.
- Mapped patient insurances will indicate Yes with a green checkmark. Proceed to step 3.
- Unmapped patient insurances will indicate No with a red x. You will need to edit and map the insurance payer to the appropriate Electronic Verified Payer.
- Once the patient’s record indicates the insurance is mapped on the case, click Save and Verify Benefits, at the bottom of the page.
- In the pop-up use the drop-downs to select the Insurance, Discipline, and Therapist or Group related to the Case the insurance needs to be verified for.
- The Insurance drop-down will only contain the Insurances listed in the patient's record.
- The Discipline populates based on the assigned therapist for the case. When choosing from the list, use the most specialized option available. However, if your clinic provides a variety of therapy disciplines. You may choose one of the grouped options. These grouped disciplines provide efficiency during verification. For instance, if a stroke patient needs PT, OT, and SLP and all three disciplines are provided in the same clinic the group option PT, OT & SLP will allow the clinic to verify all disciplines at the same time when this option is selected from the list.
- The Therapist populates based on the Therapist assigned to the case.
- Choose the Assigned Therapist NPI or Group NPI eligibility you wish to use for verifying the patient’s eligibility and benefits.
Note: When using Group eligibility ensure you have added the Group NPI number to the Group NPI for Electronic Benefit Verification in your clinic settings.
- Click Save and Verify Benefits to begin processing insurance benefits (this may take a few minutes).
Note: CMS requires a one-time validation and approval of each NPI submitting electronic verification for Medicare insurances mapped to Medicare Part A and B. This results in an immediate benefit verification rejection if the NPI has not been previously approved by CMS. Please allow two days to validate and approve the NPI submitted before initiating additional attempts to electronically verify benefits.
- A Successful verification is indicated by a green checkmark, indicating the benefits were successfully verified. Hover over the checkmark to see additional information and the date of verification.
- A Failed verification is indicated by a red checkmark, indicating the benefits were not verified. Hover over the message to see the reason the verification failed.
- In SOAP 2.0, the status of the patient’s insurance benefit verification will be indicated in the Case Summary.
Note: You can also use the INS Verifications Usage report to see a list of verified patients
- To view an example of the document from BCBS, click here.
- Click here for an example of the document from United Health Care.
Successful Electronic Benefits Verification detailsYou can find information about Successful Electronic Benefits Verification in the patient record.
The verification document provides insurance information related to the disciplines selected in step 4b, an attestation, and a signature line available for patient consent.
|Patient Case||In addition, the Verified Date is updated on the patient case.|
Case Level Verification
Case level verification is identified in the patient record on the specific case tab. When a new case is added to the patient record you will need to run the Electronic Benefit Verification for the new case. You can hover over the verification checkmark for details regarding the completed or failed verification.