What I Need to Know
How to Verify Benefits

For Out-of-Network Providers, when you verify eligibility ask the carrier how the out of network claims will be reimbursed.

More and more carriers are using the Medicare fee schedule instead of Usual Customary and Reasonable (UCR). The Medicare Fee Schedule is available online and it lists the fees for most procedures. This way you to have some idea what to collect while the patient is still in the office.

Write down your expectations for payment, this way whoever posts the payments or makes reconciliations on the account will key into any payments that are not as expected. 

From a former Customer Service Representative (me), remember that a Customer Service Rep is simply a messenger. Their role is to provide information on the plan, as written. They did not write the plan, nor do they have the authority to change it. This does not mean that you should simply accept poor service or incorrect or confusing information. If you have issues that need to be resolved, request to speak to a supervisor or manager since they would be better able to remedy the problem.

The following is a copy of a Verification Form that you can use as template for developing a form that works for you.

Back to How to Verify Benefits