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How to Verify Patient Insurance Eligibility in Simple Steps

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When it comes to the billing process of any treatment, which is the most important step? 

  • Is it documentation?
  • Is it coding?
  • Is it a claim submission?

If you do not have proper eligibility, your claim is basically dead even before it starts. Talking about eligibility, there are a lot of terms that get mentioned around checks and patient eligibility. 

It simply includes coverage, verification of benefits, eligibility, pre-authorisations or checks for benefits, and a lot more. If you think a little, you will find out that all these terms essentially mean the same thing. 

Most offices usually look for either eligibility of benefits or patient eligibility verification. This verification always allows you to go a lot deeper and find out exactly what the payer covers for a particular patient. 

This way, you will be able to determine a particular line of benefit or service which you believe will be performed in the clinic or practice. Here, you also need to remember that benefits can vary.  

So, before starting the service, you should verify whether the service covers benefits under the plan of the member or not. 

Verify patient insurance eligibility in simple steps 

Here, in this article, we will talk about how to verify insurance eligibility in some simple steps. The steps are discussed below. So, follow this and find out the eligibility of the patient insurance. 

Step 1: Collect critical patient information

First, you are required to gather all the information about the patient as soon as possible. You should remember that insurance verification is not at all a smooth process always. It means you should invest some time in completing the entire process.  

When the patient is calling for their first appointment, you should ask them to provide the below-mentioned information.

  • Name and date of birth of the patient. 
  • Insurance company’s name.
  • Primary insurance plan holder’s name along with their relationship to the patient. 
  • The policy number and also the group ID number of the patient. 
  • Phone number and address of the insurance company. 

In case the patient also has some other insurance policies, also get the details of the secondary insurance. 

Step 2: Verify the patient’s coverage information

In this next step, after collecting the necessary information, it is time to verify those pieces of information with the carrier. 

This typically included verifying information regarding payable benefits, insurance coverage, coinsurance and copays, date of coverage, details on the plan related to coverage, exclusion, type of plan, deductibles, and obviously other key details of the insurance plan.  

Here, you need to consider the verification of the patient’s coverage on all the secondary and primary payers, along with determining which one is secondary and which one is primary coverage on the basis of coordination of benefits. 

Step 3: Contact the insurance company before the patient’s visit

You have collected the information. Now, it is time to contact the payer at least 72 hours before the patient’s visit. This way, you will have all the required information before the patient visits your clinic.  

You can either contact the payer, or you can check online on the official portal of the insurance company. Giving a call to the insurance company might seem convenient, but it is time-consuming at the same time. 

Getting the connection to the concerned person might be difficult, and you might need to call after a while, as a lot of people might be calling them at the same time. You might end up wasting a whole day to get the connection.   

On the other hand, checking on the online portals is way more convenient and time-saving. You just need to offer some basic details, and it will provide the details you want to know about the patient’s insurance eligibility. 

Step 4: Complete the final formalities

Now, you have done verifying the details that are required to get verified. Now you need to complete the last step. For that, you need to interact with the patient and complete all the paperwork before providing any services.  

In case there are any type of discrepancies in the eligibility and also on the coverage information that the patient has provided and you have collected, you are required to clear them right now. 


You just need to follow these simple steps to verify the insurance eligibility of the patients. You need to ensure that you are collecting and gathering the right information from the patient and verifying them.  

In case you encounter any issues, you can contact us; we will be more than happy to help you.

Helen Baumeister did her degree in psychology at the University of Hertfordshire. She is interested in mental health, wellness, and lifestyle.

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