14 Feb Insurance Verification 101: Tips and Tricks from an Insurance Verification Specialist

An insurance verification specialist weighs in on insurance verification for the 2025 Calendar Year Turnover…

As we approach January 2025, we here at Resonate Health are gearing up for the onslaught of new  insurance verifications. Most insurance plans start or “reset” at the beginning of the calendar year, meaning deductibles are in effect and benefits may have changed. We recommend that all practices check not just new patient benefits but all established patient benefits at the beginning of the calendar year.

Now is also a great time for your practice to revisit your past struggles with insurance verifications and draft a game plan for effectively utilizing your staff’s time and efforts this upcoming year.

• Review your current system. Are you collecting all the information needed within one online look-up or call? If you use an insurance verification sheet (which we highly recommend), now is the perfect time to review your format and add anything that may have come up during the past year.
• Cover the basics: add any new authorization requirements, billing codes you may have added to your rotation, and how many units of each particular code are allowed.
• Add in things that might be specific to a single practitioner or type of care, such as whether that code you’re using falls under your modality or is a separate benefit that will incur separate charges for the patient. Remember: you may not get every answer you are looking for from the general customer service representative, but it’s always worth asking the question.
• Do you have a quick list of Provider Service Reps for each insurance you bill in case you have a deeper question regarding benefits and eligibility? Do you keep a spreadsheet of nuances for every plan? The start of a calendar year is the perfect time to start new verification habits and new spreadsheets.

Whether this is your first time dealing with calendar-year turnover verifications or you are a seasoned veteran, the process can be overwhelming.

Resonate Health has 9 insurance verification tips and tricks to eliminate that stress:

1. Website Insurance Verifications Vs. When To Call

Does your office have online access to every insurance you bill in your area? If not, we recommend designating one reliable long-term staff member in your office to be the admin and sign up for provider portal access immediately.

Have all staff who might be doing verifications watch the webinars and sign up for the classes so they are trained to use these programs to verify insurance.

How do you know if the insurance you need to verify is available online? It may take a bit of wrangling, but you can look up your insurance name online and see if they have a provider portal. Be sure that the provider portal is for your geographic area, as many insurance companies have multiple locations (and therefore multiple portals and phone numbers) nationwide.

What if the verification is missing important information? Maybe you can see everything except for whether it requires pre-authorization – now what? The best rule of thumb is to call the number on the back of the card. If you are building a spreadsheet for insurance verifications, this would be important information to add as it may be easier to call first on the next plan of a similar type.

What is the best phone number to use? This can cause numerous headaches and wasted hours. Again, the number on the back of the card is specific to that patient’s plan and is always the best place to start. The general number you find online may not be appropriate for every person.

2. Patient Information for Insurance Verifications

Usually, all you will need to perform your insurance verification is the Patient Name, Date of Birth (DOB), and insurance information. The best practice for collecting insurance information is to get a photocopy of the patient’s card, front AND back (the back is where you will find all the important insurance contact numbers).

3. Authorizations for Insurance Verifications

How important is this in all modalities? You may think you know which services or modalities require an Auth, but every year is a new battle and should be treated as such. You are already on the phone for new benefits, so don’t forget to ask about authorizations and what company they might use to obtain their Auths.

4. Exclusions for Insurance Verifications

This one thing can be so costly to an office. A general customer service rep might tell you that Acupuncture is a covered benefit, but if you didn’t ask about exclusions you may find after several visits that the patient is only covered if pregnant or if the service is performed by an MD. Moving forward, remember to ask: “Are there any exclusions to the patient’s plan?” This question is a must in the ever-changing world of benefits.

5. IN vs OON (And Why It’s Important To Get Both for Insurance Verifications)

Let’s say you only ask about IN (In-Network) benefits because you are contracted with a particular insurance company and assume you only need to know those benefits. Then, you find out that the OON (Out-Of-Network) benefits pay out at a better rate or give more coverage opportunities to the patients. So you pull out of the In-Network contract and live happily ever after getting paid better. Or vice-versa: you were told by a colleague that you should never contract with a particular company, so you don’t and only ever ask for OON benefits. Then, come to find out, they cover your modality and pay really well! You could have been contracted the whole time but you never asked! Never assume anything and be sure to revisit those insurance companies you might want to change your contract with yearly.

6. Dealing with Uncertainty

If you’re unsure of the answers you see online or hear on the phone, how do you handle it? Easy: call back. Measure twice, cut once. Or in this case: call twice, bill once!

7. Get Patients Involved

Verifying insurance in your office is a service to the patient, not a requirement. And it is also a quote, not a guarantee. We suggest going over the benefits with each patient to make sure they understand their responsibility going forward. And ALWAYS tell the patients that they should verify their own benefits and compare them with the information you received so that everyone is on the same page.

If you don’t have patients sign a financial agreement already, start immediately. Keeping the patients informed and involved strengthens your relationship with the patient and keeps you safe from unpaid charges and unforeseen patient responsibilities you may not have accounted for.

8.Get The Provider Rep Involved

Their job is to get you the information you need to bill properly and inform patients correctly. The provider representative’s contact information should be kept on your handy spreadsheet for daily use.

9. Set aside Time for Insurance Verifications

This last point is one of the most important. Designate quiet and uninterrupted time to get these benefit checks done. Select a staff member to step away from the busy front desk area (this can be done by utilizing an empty exam or practice room, working from home, or working outside of office hours) to focus on the task at hand.

It is so crucial that this information is gathered correctly. Almost every correction needed on claims submitted to insurance can be traced back to the insurance verification. By giving yourself or your staff member space to verify benefits, you are creating focused energy to absorb the information and ensure fewer errors along the way, saving you time and money.

Remember that insurance verifications don’t have to be daunting. Verifications will always be a core part of running your practice, but if you are prepared, organized, and educated, you can make it a breeze!

We at Resonate Health are here to help you succeed as an office and bring balance to your practice. Should you need guidance developing insurance verification forms, crafting spreadsheets, or more instruction in any of the above points, reach out to the insurance verification specialists at Resonate Health and watch your business thrive!