Insurance Eligibility Verification and
Pre-Authorization Services

Insulate Yourself from Expensive Write-Offs and Denials

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300M
Demo Entries
Per Year
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$380M
Charge Entries
Per Year
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1.5M
Codes Entered
Per Year
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$160M
Payments Posted
Per Year
Why BHS

Real-Time Eligibility Verification Solutions

Maximize Productivity and Process Efficiency

When exploring ways to maximize your revenue cycle efficiency and profitability, healthcare providers need not look further than the first yet vital step of the revenue cycle process - insurance eligibility verification and prior authorization. When done right, it helps providers scale revenue, and reduce denials and outstanding accounts receivables.

According to recent reports, healthcare providers spend on average 30% of their annual income verifying patient insurance eligibility as the current insurance verification landscape is becoming much more complex due to patients frequently switching insurance networks and rising financial responsibility.

Utilizing our proprietary software BristolBot™, developed in close consultation with popular insurance networks, we are able to provide a one-stop, cost-effective solution for simplifying and speeding up the eligibility verification and claim status-checking process for healthcare providers.

Most claims are denied because they are billed to the wrong insurance carrier or someone not standing tall on the eligibility status. Thus a quick and detailed check of patients' insurance eligibility goes high just before admission. We understand this well and offer a robust eligibility verification service to make your claims immune against insurance denials.

Process

A Systematic Approach

Our comprehensive eligibility verification and pre-authorization solutions are purpose-driven to boost your revenue cycle performance. Guaranteeing 100% acceptance of claims submitted.

  • Get in touch with patients to collect information upon receiving their schedules through email, FTP, or fax.
  • Verify their status as both primary & secondary payers.
  • Revise demographic and other relevant information.
  • Update your billing system with verification and eligibility details such as coverage start and end dates, group ID, member ID, co-pay information, etc.
Female doctor on a phone call to verify patient information.
Group of happy doctors and nurses.
Benefits

Why Partner With Bristol Healthcare?

  • Make your claims immune to insurance denials.
  • Streamline your revenue cycle process.
  • Expedite reimbursements and minimize delays.
  • Increase productivity and process efficiency.
  • Ensure 100% payment collections.
  • Expedite approvals and authorizations.
  • Real-time verification with batch upload features.
  • Utilize certified professionals equipped with the latest technology.
  • Exclusively allocated team and project manager to handle all critical bills and customer calls.
  • Check details like co-pays, payable benefits, deductibles, co-insurance, patient policy status, etc. in real-time.
  • Update plan exclusions, plan type and coverage details, effective date, pre-authorization, and referrals, claims mailing address, etc.

Apart from that, we also help keep tabs on current health insurance policies to ensure maximized benefits for your patients. Our team of certified billing professionals are continuously educated on the latest developments to set you up for success right from the get-go.

Let’s Connect

Schedule a Free Consultation Today

Call or email us to schedule a no-commitment, free consultation today to learn how partnering with Bristol Healthcare can benefit your practice.

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Software

Multi-Software Expertise

Our team of experts are well versed and experienced with most of the popular software used by clients today.

Help Center

Your Questions Answered

Insurance Eligibility and Benefits Verification

Insurance eligibility and benefits verification is the process of confirming a patient's insurance coverage, including details on deductibles, co-pays, coverage limits, and any pre-authorization requirements.
Verifying insurance eligibility helps avoid claim denials and ensures that patients are aware of their financial responsibilities. It also enables proper planning for any pre-authorization requirements.
We use electronic tools and platforms to verify insurance eligibility in real-time. This allows us to obtain accurate and up-to-date information about a patient's insurance coverage.
If we identify incorrect or outdated information, we will work directly with the patient to obtain the correct details. This may include contacting the insurance company or the patient for clarification.
Yes, we have the capability to verify eligibility for various insurance plans, including commercial insurance, Medicare, Medicaid, and others.
Accurate insurance eligibility verification ensures that claims are submitted to the correct payer, reducing the likelihood of claim denials. It also helps in accurately estimating patient responsibility and co-pays.
We strictly adhere to HIPAA regulations and use secure, encrypted channels for all communications related to insurance verification. Access to patient information is restricted to authorized personnel only. Learn more about our compliance protocols.

Insurance Claim Status Check

An insurance claim status check involves verifying the status of a submitted claim with the insurance company. It helps in tracking the progress of a claim and identifying any issues that may need to be addressed.
We perform regular claim status checks to ensure timely processing. The frequency may vary based on the specific requirements of the insurance company and the nature of the claim.
If a claim is denied or delayed, we conduct a thorough review to identify the reason. We then take appropriate action, which may include resubmitting the claim with corrected information or initiating an appeal.
Yes, we can provide real-time updates on claim status through our secure online portal or via email, ensuring that providers are always informed about the progress of their claims.
We have systems in place to efficiently manage claim status checks for multiple payers. Our team uses electronic tools and platforms to streamline the process. Learn more about BristolBot™.
Yes, we have a dedicated team that specializes in identifying and resolving claim discrepancies. This includes addressing issues related to coding, billing, and payer-specific requirements.
Yes, we have the capability to perform claim status checks for both electronic and paper claims, ensuring a comprehensive approach to claims management.

Prior Authorization

Prior authorization is the process by which healthcare providers obtain approval from an insurance company or payer before performing a specific medical service, procedure, or medication prescription. It ensures that the proposed treatment is medically necessary and covered by the patient's insurance plan.
We have a dedicated team that specializes in obtaining prior authorizations. This team communicates with insurance companies, submits the required documentation, and tracks the progress of each authorization request.
For urgent cases, we expedite the prior authorization process by providing all necessary documentation promptly. We also maintain open communication with the insurance company to expedite the approval process.
Common requirements include the patient's demographic information, medical history, diagnosis, procedure codes, supporting clinical documentation, and the provider's information.
Common reasons for prior authorization denials include incomplete documentation, lack of medical necessity, and coding errors. We address these issues by ensuring all necessary information is provided and by appealing denials when appropriate.
If a prior authorization is denied, we conduct a thorough review of the denial reason. Depending on the situation, we may appeal the decision, provide additional information, or explore alternative treatment options.
Yes, we have experience in assisting providers with retroactive prior authorizations, working closely with insurance companies to obtain the necessary approvals.
Testimonials

What Our Clients Say

Together with our clients, BHS experts partner to achieve desired outcomes
and push the boundaries of what's possible.