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How to Reduce Insurance Denials With Verification?

Healthcare professionals continue to share frustration about insurance verification gaps. One provider described: “We are having issues with getting insurance verification benefits resulting in denials and loss of revenue. Front desk staff is not doing their job properly causing headaches with billing.”

This single comment reflects a wider issue across hospitals and clinics. Missed or incomplete insurance verification leads to denials, delayed payments, and dissatisfied patients. The challenge has sparked conversations about whether software can solve the problem, which EMRs provide the best integrations, and whether outsourcing verification tasks might finally reduce the headaches.

The Cost of Missed Insurance Verification

Many clinics underestimate how much revenue is lost when benefits are not properly checked. As one user admitted: “Our IV process is a nightmare. Large part of that also due to 90% or more are managed Medicaid/Medicare plans.”

Managed care plans come with stricter rules for eligibility and prior authorizations. A single missed verification can mean:

• Denied claims that require rework

• Patients billed unexpectedly for non-covered services

• Delays in scheduling necessary treatments

When the front desk misses these checks, providers feel the financial impact immediately. “Front desk staff is not doing their job properly,” one clinic reported, highlighting the direct connection between staff performance and revenue loss.

Manual Verification: Time-Consuming and Inconsistent

Healthcare professionals consistently note how manual verification drains time. One provider shared: “I use onebody occasionally when I want to be sure and I don’t want to sit on the phone to verify myself. It’s 5 dollars per verification.”

The common workflow still involves:

• Calling payer phone lines

• Logging into multiple insurance portals

• Entering benefit details into spreadsheets or EMRs

This manual effort is inconsistent across staff members and nearly impossible to scale when a clinic sees dozens of new patients each week. Errors during this process directly increase denials.

Prior Authorization Adds Another Layer of Complexity

Forum members also discussed the overlap between insurance verification and prior authorization. A physical therapist explained: “It’s really impossible to have an automated system for prior authorization. You can use Excel to track, and certain EMRs have authorized visit tracking built into them, but actually doing the prior authorization is still manual at this point.”

This reflects a key challenge: while eligibility and benefit checks can be automated in some EMRs, prior authorization still requires staff oversight. Submission forms, clinical documentation, and payer follow-ups remain manual. Without dedicated staff, authorization delays often disrupt patient care and revenue flow.

EMR Systems With Integrated Verification Features

Some healthcare providers have found success using EMRs with built-in verification. One clinic noted: “We moved to an EMR called SpryPT last year, and they have integrations with multiple clearing houses. We usually get benefit details in a click now right within the EMR.”

Another professional explained how SpryPT helps their front desk: “Once the insurance is entered into the patient’s chart, you can click ‘Check Eligibility’ and it will pull the patient’s eligibility and benefits. It will also add the copay to the appointment, so your front desk will know how much to collect.”

Others mentioned runtalos.com, which integrates with eClinicalWorks: “It works with any EMR and it is fully automated and generates a clean report when we run verifications every day.”

While these tools reduce workload, healthcare professionals caution that they cannot replace trained staff. “Only some pre-auth cases don’t show up. Else, the accuracy is pretty solid,” one user admitted, confirming that oversight is still needed.

How Virtual Insurance Verification Specialists Help ?

Technology helps, but human oversight is essential. Staffingly’s Virtual Insurance Verification Specialists combine EMR tools with manual checks to ensure every patient visit is verified.

These specialists:

• Verify eligibility, deductibles, and copays before visits

• Manage payer portal checks daily

• Track and submit prior authorization requests

• Provide clean documentation for billing staff

Because they operate from India and Pakistan, with additional support from the Philippines, specialists often have healthcare backgrounds as MDs, Nurses, or PharmDs. This clinical knowledge helps them interpret payer policies correctly.

At $9.50/hour (under $2,000 per month), virtual specialists cost far less than hiring local staff — typically $4,500–$6,000 per month. This provides up to 70% cost savings while reducing denials and payment delays.

The AI + Human Strategy for Insurance Verification

Automation cannot stand alone. As one professional commented: “You should barely need to call anyone besides needing to clarify if prior Auth is needed vs getting basic benefits via online portals.”

The most effective approach is combining EMR automation with virtual specialists who manage exceptions and ensure accuracy. Automated eligibility checks save time, while human oversight ensures that payer-specific rules, prior authorizations, and edge cases are not missed.

Stop Insurance Verification Errors From Hurting Your Revenue

Healthcare professionals are tired of saying: “Our IV process is a nightmare” and “front desk staff is not doing their job properly causing headaches with billing.”

You don’t need to keep losing revenue from missed verifications and preventable denials.

Stop Denials From Poor Insurance Verification

Staffingly’s dedicated specialists handle the entire verification process so your front desk can focus on patients.

15-Day Insurance Verification Trial

✓ Virtual Insurance Eligibility Verification – daily checks for benefits, copays, and deductibles before every appointment.
✓ Prior Authorization Specialists – manage payer portals, track approvals, and submit appeals when needed.
✓ Revenue Cycle Support – reduce denials and keep claims moving smoothly.

Healthcare professionals using EMR tools admit: “Our IV process is still a nightmare.” Staffingly ensures it isn’t.

HIPAA-compliant. Healthcare-specialized. Starting at $9.50/hour. Under $2,000 monthly vs $6,000 for in-house staff.

What Did We Learn?

• Missed or incomplete insurance verification leads directly to denials and lost revenue.

• Front desk staff performance is often inconsistent, causing billing headaches.

• Manual verification is time-consuming and prone to errors, especially with Medicaid and Medicare managed plans.

• EMRs like SpryPT, eClinicalWorks, and Runtalos help automate verification, but still require oversight.

• Prior authorization remains mostly manual, needing dedicated staff to track and submit.

• Virtual specialists from Staffingly can perform daily verifications, manage prior auth, and reduce denials at 70% lower cost.

• The best approach is AI + Human oversight — automation combined with trained virtual teams.

What People Are Asking?

Is there any software that does insurance verification for you? Is it worth it?

Yes, many EMRs like SpryPT and platforms like Runtalos offer automated eligibility checks. They save time but still need staff or virtual specialists to handle exceptions and prior auth.

How can we reduce denials from insurance companies?

By verifying eligibility before visits, tracking prior authorizations, and documenting payer requirements. Many clinics use virtual insurance verification specialists to ensure no gaps.

Which EMR systems do you recommend for benefit verification?

Providers recommend SpryPT (integrated clearinghouse), eClinicalWorks, and Runtalos for daily automated reports. These reduce manual calls but still require oversight.

Does educating patients to check their policies help?

Yes, but only partially. Patients can confirm coverage, but payers often require provider-side verification. It works best as a supplement, not a replacement.

Can prior authorizations ever be automated, or is it always manual?

Currently, prior authorization is still manual. EMRs may track visit limits, but submission and follow-up need dedicated staff or virtual specialists.

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.