Insurance eligibility verification is the foundation of clean medical billing. At OptumRCM, we emphasize accurate eligibility checks to prevent denials, payment delays, and patient billing disputes.
Why Eligibility Verification Is Critical
Incorrect insurance information can lead to:
- Claim denials
- Delayed reimbursements
- Increased patient balances
- Additional administrative workload
Best Practices Followed by OptumRCM
Our eligibility verification process includes:
- Confirming coverage prior to each visit
- Verifying copays, deductibles, and coinsurance
- Checking authorization and referral requirements
- Ensuring provider network eligibility
Technology + Human Review
While payer portals and automation tools improve efficiency, OptumRCM combines technology with expert review to catch plan-specific limitations that automated systems often miss.
Final Thoughts
Accurate eligibility verification significantly improves first-pass acceptance rates. By working with OptumRCM, practices can minimize denials, accelerate payments, and improve the patient financial experience.