How Long Does Insurance Eligibility Verification Take?

Eligibility verification is one of the key elements of the medical billing process. Healthcare providers must verify whether a patient has active health care insurance prior to rendering services and which services are covered under their policy. Proper verification prior to the delivery of care avoids billing errors and claim denials and reduces the risk of a financial burden on the patient.

Many healthcare organizations inquire, “How long does it take to perform insurance eligibility verification?” Depending on the type of insurance verification—automated or manual—the payer’s response timeline, and other factors, the time required to receive an eligibility verification response varies significantly, as does how efficiently the practice processes their verification requests.

What is Insurance Eligibility Verification?

Insurance eligibility verification is the verification of a patient’s health care insurance prior to the delivery of medical services. It verifies all aspects of a patient’s insurance coverage, which include:

• Whether the patient’s insurance plan is valid.
• What medical care does the patient’s insurance cover?
• Patient responsibility for copayment, deductibles, and coinsurance.
• Whether the patient’s primary care physician must provide a referral or approval.

Proper insurance eligibility verification provides medical billing verification efficiency and minimizes the potential for costly claim denials.

Average Response Times for Typical Eligibility Verifications

The average response times for typical eligibility verifications vary significantly, based upon the type of eligibility verification requested by the healthcare provider.

Automated/Real-Time Verification (0-2 Minutes).

Some providers have implemented automated systems that electronically request eligibility information from payers. With an automated system, electronic requests are sent to insurance companies, and the payer responds electronically within seconds. The real-time eligibility response time is generally within 1-2 minutes. This information is often delivered via electronic data interchange.

Real-time eligibility provides immediate confirmation.

Since this is the fastest and most efficient way to confirm eligibility, a same-day insurance eligibility check can be completed during the patient’s registration process.

Automated Batch Verification (1–24 Hours)

Automated batch insurance verification can be accomplished in a matter of hours (1-24 hours). In some instances, an organization may have an automated system that verifies many patient records at one time.

• Insurance verification processing speed: Typically, a few hours.
• Method of receiving responses: Responses are received electronically.
• Typical completion: Often completed within the same business day.

This is commonly practiced in larger healthcare practices that process hundreds of patient verifications daily.

Manual Insurance Verification (15 Minutes to Several Hours)

Manual insurance verification is accomplished by having staff contact insurance companies via telephone calls or using a payer’s portal.

• Comparing manual vs automated insurance verification: Manual methods are generally much slower than automated systems.
• Timeframe for verifying eligibility via manual means: 15 minutes to several hours per patient;
• Factors affecting response time: Response time will depend upon the length of the hold times as well as the availability of the payer’s systems.

When should manual verification be used? When automated systems cannot provide accurate data or when the complexity of coverage details necessitates it.

Understanding EDI Eligibility Response Time

Electronic Data Interchange (EDI) is used in the healthcare billing industry to facilitate the exchange of information between providers and insurance companies. EDI plays a large role in accelerating the rate of insurance eligibility checks.

The typical response time for an EDI eligibility response is the following:

• Real-time electronic verification: 5-30 seconds;
• If there are delays with the payer’s system, A few minutes.

Using EDI-based verification greatly increases the medical billing verification efficiency by providing a means to eliminate the need for manual phone calls and paperwork.

Factors Affecting Insurance Verification Processing Speed

There are a number of variables that will impact how long it takes for an eligibility verification determination to be made.

Type of Verification Method

The type of method used (manual vs. electronic) is the biggest variable that will impact how quickly an eligibility verification determination is made. Electronic methods are much quicker than manual methods.

Insurance Company Response Time

Each insurance company has its own level of capability when it comes to processing claims. Therefore, some payers will immediately confirm a patient’s eligibility to receive care from your organisation, while other payers may take longer to confirm a patient’s eligibility.

Completeness/Correctness of Patient Data

If there are missing pieces of information about a patient, or if the data entered into your system contains errors, this could delay the eligibility verification workflow timeline.

Common examples of these types of problems include the following:

• Patient data entry error due to misspelling of name
• Policy misspelling
• Date of birth is incorrect.

Complete and accurate data entry will help prevent delays in the verification process.

Technical Issues

System connectivity issues experienced by either the payer or clearinghouse can create technical difficulties that impede the delivery of the EDI eligibility response time and, therefore, temporarily delay the verification process.

Complexity of Coverage

Patients with secondary insurance, patients covered under government programmes, and patients with special coverage may require additional verification steps prior to receiving their insurance verification determination, as well as increase the speed of insurance verification processing.

Common Causes of Delays in Verifying Insurance Eligibility

Although new technologies are available, it is possible for delays to still happen during eligibility checks. The most common reasons for insurance verification delay causes

• outdated insurance information
• slow response time from the patient’s payer portal
• long wait times at the call centre
• network/clearinghouse issues
• high volume of verifications during peak hours

By identifying the above-mentioned challenges, healthcare practices can improve the medical billing verification efficiency.

Benefits of Fast Eligibility Verification:

 Fast insurance eligibility verification will benefit both the healthcare provider and the patient.

Reduced Claim Denials

Earlier that a healthcare provider verifies the patient’s insurance, the less likely they will be to make an error on a bill that will result in the claim being denied by the payer.

Better Patient Experience

Patients will have a better understanding of what they will be expected to pay for services prior to receiving them.

Allows for Same-day Scheduling: 

A same-day insurance eligibility check allows a practice to verify whether the patient has coverage prior to making an appointment, which can reduce delays.

More efficient revenue cycles and

Faster eligibility verification can also lead to faster billing cycles and quicker payments to your practice.

Strategies to Enhance the Speed of the Medical Billing Verification Process

Practices can do many things to make the verification process faster:

• Automate the eligibility verification process using the Eligibility Verification software.
• Use Electronic Data Interchange (EDI) technology for quicker payer responses.
• Provide training to all staff on how to enter the correct information into the system.
• Verify the patient’s insurance coverage when making an appointment for services.
• Conduct batch verification for future appointments.

These are some ways to enhance your insurance verification processing speed and therefore reduce the opportunity for delays in verifying patients’ insurance coverage.

Conclusion

Eligibility verification processing times may be anywhere from a few seconds to several hours, depending upon the methodology being utilized. Automated systems generally produce a faster real-time eligibility response time as compared to manual ones, and automated systems will also generate eligibility confirmations instantly. Manual vs. automated insurance verification comparisons show that manual verifications generally take longer to process than automated ones.

Use of electronic data interchange (EDI) systems will allow for increased speed in processing insurance verifications, enabling healthcare providers to do same-day insurance eligibility checks for treatment services. By enhancing your eligibility verification workflow timeline and decreasing or eliminating common reasons for delays in insurance verification processing, you will enhance the overall efficiency of your medical billing verification process, ultimately resulting in easier billing processes.