Computers in Medicine Online (sm)


Computers in Medicine (sm) –   Online Newsletter is a quarterly online newsletter on computer applications for   the medical profession (Published on the Web since 1996)

4th Quarter ‘2010 Edition



Insurance Eligibility Verification

The Traditional Phone Method:

There is no doubt that Insurance Eligibility Verification is a necessary part of properly managing a heathcare practice.  In the past, the process of verifying a patient’s insurance was a typically cumbersome undertaking that quite often involved placing a telephone call to the insurance carrier and obtaining the information you needed only after waiting on hold for very long periods of time.  Many practices still check for insurance eligibility in this manner.  It is an unnecessary and wasteful use of the practice’s staff and/or billing company’s time.

The Web-Based Carrier Website Method:

Many carriers are now offering web-based access to verify an insured member’s eligibility.   While these services are usually free-of-charge and more efficient than the older phone method mentioned above, they also present another set of drawbacks.  When using these carrier-based online eligibility services, the staff-member needs to navigate to each carrier’s individual website and enter the user id and password corresponding to each of these websites.  To further complicate matters, the resulting insurance eligibility information is presented to the staff-member in a variety of different formats causing more time spent finding the specific information they are looking for.

The Real-Time Insurance Eligibility Verification Service Method:

Currently there are some companies offering Real-Time Insurance Eligibility Verification Service.  Many of these companies charge a small monthly fee to subscribe to their service, whereby a staff-member can logon to a website that provides electronic insurance eligibility verification information for a multitude of carriers.  The advantage here is that you only have to logon to one website (with one user id and password) to search and find insurance eligibility information.  This method is much more efficient that the previous 2 and can reduce the work of your staff significantly freeing them up to perform other job functions.  The only significant drawback here is that the staff-member using this service needs to enter identifying information for each patient whose eligibility is being checked for.

The Integrated Real-Time Insurance Eligibility Verification Method:

Some practice management systems are now offering “Integrated” Real-Time Insurance Eligibility Verification.  This usually requires a subscription to a company that offers an electronic eligibility verification service, just like the method mentioned above, but here we have the additional benefit of being integrated to the practice management system like the Brickell Medical Office.  In the case of the Eligibility feature found in the Brickell Medical Office, a back-office staff-member can simply bring up a patient on the system and click a button to obtain the patient’s insurance eligibility verification information in real-time, so there is no need to re-enter patient identification information!  A staff-member working the scheduler at the front-desk has the same capability as the back-office, in fact, they can also generate a report showing the real-time eligibility information for all patients scheduled on that day, and do so with the clicks of a few mouse buttons!  The increased productivity provided by a practice management system with Integrated Real-Time Insurance Eligibility Verification is simply unobtainable using any of the other methods.

For more information on Brickell’s Integrated Real-Time Insurance Eligibility Verification feature, click here.


There was an overwhelming interest in the issue regarding Practice Management Systems and Electronic Medical Records.  Click here to read it.


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Last Update: 10/1/2010

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