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URGENT: Healthcare Providers Need to Verify Patients’ Eligibility in 2018

With a new year upon us, have you taken time to verify patient’s eligibility and insurance benefits? If not, it might mean you don’t get paid for services rendered. Many plans reset deductibles and visit limitations with the calendar year – you may want to remind your patients of that before they schedule appointments. Some plans come with high deductibles and the last thing you want is to have a patient in the office unable to meet that newly reset deductible.

Take the time to obtain updated insurance information before patients arrive in the office. You may even want to create a policy or procedure in your office to verify eligibility when a patient schedules an appointment. Once verified, communicate with the patient ahead of time if there will be unexpected costs and if applicable, remind them that payment will be due on the date of the appointment. It may sound time consuming, but it’s less time consuming and less expensive than rendering services and not getting paid or having an upset patient surprised by a high deductible.

In addition, be aware of some changes that came with 2018. Health Net Federal Services is now providing services to TRICARE beneficiaries in California. They are taking over the contract from United Healthcare Military and Veteran’s Services. Double check to ensure this change will not affect your ability to get paid. Also, Anthem Blue Cross is leaving the California exchange in some regions of California this year – this could affect your patients. Be aware of these changes and double check verifications to ensure you get paid without delay.

With open enrollment closing in California on January 31, 2018, now is a great time to verify patients’ eligibility. Do the work ahead of time to avoid a headache and loss of money later in the year. And if you create sound office policies and procedures this year, you can use the same system this time next year and in the future.

*80% of money is around medical issues



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Wit of Mandate - the official blog of Simas & Associates, Ltd., is made available by Simas & Associates, Ltd. to the general public for educational purposes only.  Specifically, the entries contained within Wit of Mandate are designed to provide the general public with general information concerning California and Federal law.  Wit of Mandate does not provide specific legal advice and does not create an attorney-client relationship between the reader and Simas & Associates, Ltd.  Wit of Mandate is not an effective or appropriate substitute for obtaining legal advice from a qualified attorney licensed in your state with experience in your practice area or forum of law.

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