Hot Topic: Verifying Insurance

Hot Topic: Verifying Insurance


Join Susie & Kristen as they role play how to call an insurance rep to verify benefits. Copy & paste our "Cheat Sheet" below into your own documentation system to keep yourself calm, collected, and on track while you call!


Ready, Set, Treat! Cheat Sheet to Verify Benefits


Things to have in prep to call insurance company:


1. Individual & PLLC NPI

2. PLLC fax & phone number

3. Client & Subscriber Name

4. Client & Subscriber DOB

5. Client Member ID

6. EOBs (if calling in regards to a past claim)


What to ask:


1. Is outpatient <your discipline> a covered benefit?

2. Any caps to yearly visits? Combined with any other discipline?

3. Referral or Prior Auth Required? (If needed, where to find Prior Auth Form?)

4. Any deductible remaining?

5. Once deductible is reached, any copay or coinsurance?

6. Rep’s name & reference #


*DOCUMENT this convo in the Billing section of your EMR!