Handling denials due to eligibility

When you find out that there are eligibility related issues, put these patient appointments in an “appointments at risk” bucket.

Categorized as Operations Tagged

This immediately tells you that you need to have better training at the front desk. Maybe the front desk does not have a good grasp of how important their job is?

It also tells you that you need to train your front desk and scheduling team to do a better job at rescheduling appointments that failed eligibility checks.

You would even have cases where the provider is considered out of network (based on the work that your credentialing team has done).

When that’s the case, you can change the provider for that appointment to one that is considered in-network for this particular patient’s plan. Or, you can communicate the issue with the patient. 

When you find out that there are eligibility related issues, put these patient appointments in an “appointments at risk” bucket.

Your frontdesk or scheduling team should call these patients before the appointment and apprise the patient of their options. The patient can either cancel the appointment, reschedule the appointment until the insurance issues are resolved or they can choose to pay from their own pockets.

The workflow you are using here (or modifying) is that the billing department analyzes the denials, forms buckets, then trains / informs the front desk to make corrections upstream. This strategy allows you to reduce such denials moving forward.