Denied claims cost healthcare practices and hospitals millions of dollars every year, both in lost revenue and the high cost of rework. On average, it costs a practice $25 per claim and a hospital $181 per claim just to appeal or rework denied submissions. Proper eligibility verification is one of the most impactful step to reduce denials and protect your bottom line.
Here’s how practice can use proven eligibility verification techniques to minimize claim denials, accelerate reimbursements, and ensure financial stability.
The Role of Eligibility Verification
Eligibility verification ensures that the patient’s insurance is active, covers the services provided, and meets all preauthorization requirements. Inaccurate or incomplete patient data, such as incorrect demographics and policy numbers, are among the top reasons for claim denials.
At MBNC, we stress the importance of verifying every detail before care is delivered. When done properly, eligibility verification helps reduce billing errors, improves patient transparency, and ensures faster, cleaner claim submission.
Proven Eligibility Verification Techniques That Reduce Denials
Understand Payer Requirements
Most practices work with 15–20 insurance providers, each with unique rules and requirements. According to the Medical Group Management Association (MGMA), most claim denials are preventable, and a majority relate to eligibility and coverage issues. Understanding payer nuances and building strong relationships with them can streamline claim resolution and minimize rejections.
Confirm Patient Information at Every Visit
Patients frequently change insurance providers, plans, and personal information. To avoid discrepancies, implement a standardized protocol for verifying patient details at every visit, including:
- Insurance ID and plan details.
- Address and contact information.
- Policyholder information.
This reduces the chance of coverage mismatches or claim delays.
Prioritize Eligibility Checks and Prior Authorizations
Failing to verify eligibility or obtain prior authorizations is one of the most common, but avoidable, reasons for denial. A 2024 MGMA poll found that a vast majority of providers were cited missing authorizations as the top cause of claim denials. Even if authorizations were secured for one part of treatment, additional services must be checked and authorized separately. Verifying eligibility at every patient touchpoint ensures full transparency and coverage compliance.
Stay Up to Date on Payer Policies
Insurance policies and billing requirements change frequently. Stay proactive by reviewing payer updates, attending training sessions, and subscribing to payer alerts. Practices that stay informed can spot red flags early, before a claim is denied due to outdated information or policy changes.
Code to the Highest Level of Accuracy
Accurate coding is critical to a successful claim. Use the most current CPT, HCPCS, and ICD-10 codes. Avoid common issues like upcoding, unbundling, or outdated codes, all of which can trigger denials or audits. At MBNC, we help practices implement internal protocols that prioritize coding accuracy to maintain compliance and maximize reimbursement.
Implement Strong Claims Follow-Up Procedures
An effective eligibility verification process doesn’t end at claim submission. Follow-up is key to preventing revenue loss. At MBNC, we recommend:
- Reviewing outstanding claims 30–45 days post-submission.
- Monitoring payer portals for real-time claim status.
- Documenting all interactions and reprocessing denials promptly.
With proactive follow-up, practices can recover payments faster and prevent aging A/R from slipping through the cracks.
Educate and Train Frontline Staff
Your front-desk and billing staff play a vital role in ensuring clean claims. Even small data entry errors can result in denials. Educating staff about the importance of accurate patient data collection, the revenue cycle, and changes in payer policies empowers them to identify issues before claims are ever filed. At MBNC, we recommend regular training sessions to keep staff up to date on new insurance guidelines and evolving billing procedures.
Partner with MBNC to Your Improve Financial Performance
As a healthcare provider, your time is best spent delivering care, not chasing claims. At MBNC, we take ownership of your billing process with end-to-end eligibility verification, denial management, and revenue cycle optimization. With MBNC, you get:
- Eligibility check and verification.
- Prior authorization tracking and compliance.
- Accurate coding and claim submission.
- Proactive denial resolution and appeals.
- Transparent performance reporting and regular consultation.
Ready to Reduce Denials and Strengthen Your Revenue Cycle?
Let MBNC help you eliminate avoidable claim denials and streamline your billing processes. With our expert support, your practice can improve cash flow, minimize rework, and focus on what matters most, patient care.
Contact MBNC today to get started on building a healthier, more financially resilient practice.
