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What are the best tips for pulling accurate insurance information?

Eligibility verification is a foundational step in revenue cycle management, ensuring that patients’ insurance coverage is active and their benefits are clearly understood before services are rendered. One of the most efficient tools for this process is the Availity Essentials Portal, which enables real-time access to insurance verification for multiple payers through a single login.

Staffingly leverages Availity and similar portals to verify coverage quickly, reduce administrative errors, and ensure patients and providers are aligned on coverage and cost responsibilities.

Why Use Availity for Eligibility Verification?

The Availity Portal streamlines the verification process for both front-desk and billing staff. Here’s why it’s a preferred tool in the healthcare industry:

1. Real-Time Results: Availity provides instant access to insurance eligibility and benefit information from a wide range of payers, enabling same-day confirmation of coverage.

2. Centralized Platform: Staffingly uses Availity to verify patients across multiple insurers without needing separate logins or calls to each payer.

3. Comprehensive Data: The portal retrieves key financial and coverage details including copays, coinsurance, deductible balances, and authorization requirements.

4. Improved Accuracy: By relying on standardized digital entries, Staffingly reduces the chances of manual data entry errors that could otherwise result in claim denials.

How Staffingly Uses Availity for Eligibility Verification?

Staffingly integrates the Availity Portal into its workflow to deliver fast, reliable, and documented insurance checks for healthcare providers. Here’s how our team enhances the process:

• Portal Access and Payer Selection: Staffingly employees log in to the Availity Portal and select the appropriate payer and service date for the patient. This ensures we retrieve the correct data tied to the patient’s appointment.

• Data Entry Accuracy: Patient details such as name, date of birth, and insurance ID number are double-checked for accuracy before submission.

• Comprehensive Review: Once the portal returns the eligibility result, our team verifies coverage status, benefit types, cost-sharing elements, and any special requirements like referrals or authorizations.

• Documentation and Reporting: We document every eligibility check in the patient’s record and provide clear, standardized notes that reflect current coverage and out-of-pocket expectations.

• Communication with Providers: Key coverage details are relayed back to your administrative staff or integrated directly into your EHR/billing system for easy reference.

How Does the Verification Process Work?

The step-by-step process that Staffingly employees follow using the Availity Portal includes:

1. Login and Navigation
   Staffingly logs into the Availity Essentials Portal and selects Eligibility and Benefits Inquiry under the Patient Registration menu.

2. Provider and Patient Details
   We enter provider information and carefully input the patient’s insurance ID, name, date of birth, and relationship to the subscriber.

3. Service Date and Benefit Type
   The date of service is selected, and the correct benefit/service type (e.g., health plan coverage) is chosen to ensure the appropriate data is returned.

4. Submit and Review
   The eligibility request is submitted in real time. Once results are returned, Staffingly reviews coverage status, deductible balances, copay amounts, and notes any required referrals or pre-authorizations.

5. Documentation and Sharing
   The verified information is logged into your system. Staffingly also provides a printable summary or screenshot of the eligibility verification for recordkeeping.

What Information Is Verified Through Availity?

The Availity Portal enables Staffingly to verify a range of key data elements including:

• Insurance Plan Status: Confirms whether the plan is active on the scheduled date of service.

• Service Coverage: Identifies which services (office visits, labs, imaging, etc.) are included under the patient’s plan.

• Copayment & Coinsurance Amounts: Specifies the out-of-pocket fees due from the patient for each type of service.

• Deductible & Out-of-Pocket Balances: Details how much of the deductible has been met and what remains.

• Referral or Authorization Requirements: Flags whether additional steps are needed before services can be provided.

When Should Verification Be Performed?

Staffingly performs eligibility checks prior to every appointment, with special attention in the following scenarios:

• New Patients: Verification is conducted immediately after scheduling to ensure coverage before the first visit.

• Returning Patients with Changes: Insurance is re-verified if patients report changes to their carrier, policy, or plan year.

• Recurring Visits: For patients on regular schedules (e.g., physical therapy or infusion), Staffingly conducts periodic checks to confirm ongoing coverage and detect any changes.

How Technology Supports the Process?

Technology plays a central role in enhancing speed and accuracy during eligibility verification. Staffingly utilizes platforms like Availity for:

• Real-Time Access: Instant retrieval of up-to-date insurance data from multiple payers.

• Automation & Integration: Eligibility information is directly entered into patient records, reducing duplicate entry and saving time.

• Secure Handling of PHI: All data is managed in compliance with HIPAA and payer requirements, ensuring both security and audit readiness.

Common Challenges and How Staffingly Solves Them

Despite Availity’s robustness, insurance verification can still face obstacles. Staffingly’s proactive approach addresses these:

• Incomplete Patient Info: We contact the provider or patient to resolve missing or incorrect details before submission.

• Plan Complexity: For dual insurance or Medicare Advantage plans, we verify both primary and secondary coverage with proper coordination of benefits.

• Limited Payer Data: If a payer does not return full benefits data through Availity, we supplement with direct payer calls or alternate portals.

Tips for Pulling Accurate Insurance Information

To ensure clean data and reduce claim denials, Staffingly follows these best practices:

• ✅ Always double-check spelling of patient name, DOB, and member ID.

• ✅ Choose the correct payer and plan based on the ID card, not assumptions.

• ✅ Re-verify any time a plan changes or a new card is presented.

• ✅ Note the effective/termination dates coverage might not be active yet.

• ✅ Confirm the benefit type matches the service provided (e.g., behavioral health vs. medical).

• ✅ Document copay/deductible clearly for financial transparency.

What Did We Learn?

Eligibility verification through Availity is an essential, front-line defense against billing delays and claim denials. By leveraging Staffingly’s trained team and proven workflow, healthcare providers can eliminate administrative stress, ensure full payer compliance, and deliver a smooth, informed experience to patients.

With Staffingly managing insurance verification through tools like Availity, providers benefit from:

• ✔️ Faster eligibility checks

• ✔️ Accurate benefit documentation

• ✔️ Reduced billing surprises

• ✔️ Higher clean claim rates

• ✔️ Happier patients

Let Staffingly handle the details, so you can focus on what matters most delivering exceptional care.

What People Are Asking?

Q: What is the best way to verify insurance coverage?
A: Use real-time portals like Availity to confirm active coverage and benefit details before the appointment.

Q: How does Staffingly ensure insurance data accuracy?
A: Staffingly double-checks patient demographics and policy information before submitting eligibility inquiries.

Q: What patient details are critical for accurate verification?
A: Patient name, date of birth, insurance ID, and relationship to the subscriber must match the insurance card exactly.

Q: Why is verifying coverage status important?
A: It prevents claim denials and ensures patients are financially prepared before receiving care.

Q: What information should be reviewed in a verification result?
A: Review coverage status, copay, deductible balance, coinsurance, and any referral or authorization requirements.

Disclaimer

For informational purposes only; not applicable to specific situations.

For tailored support and professional services,

Please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com.

About This Blog : This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.