Revenue360 Insurance Eligibility Verification

Insurance eligibility verification

Eligibility Module

The Revenue360 Insurance Eligibility Verification Module initiates a real-time 270 eligibility request at the earliest point in the registration and scheduling process, returning customized 271 benefit information to your revenue cycle team – all based on your hospital specific business rules. Integrated with your hospital information systems, verifying insurance at the point of service allows your staff to collect co-pays and deductibles immediately while improving staff efficiency.

Insurance eligibility verification

Check patient insurance eligibility in real-time for hundreds of payers nationwide!

  • Real-time access to 700+ Payers
  • HIPAA compliant processing
  • Customized, facility-specific response summaries
  • Web-based worklisting & reporting 
  • One-off processing for manual verification
  • Easily look-up historical responses for claim dispute resolution
  • Integrate Pricing Estimation to calculate total out-of-pocket cost
  • Add Payment Processing to process patient copays
  • Find Retroactive Insurance coverage with the ReInquiry Module (RIM)

Revenue360® can connect to any health plan that offers real-time eligibility transactions or website eligibility access. No need to spend additional time on the phone waiting for verification or switching to payer websites to gather the information and re-enter into your registration system. And, no need to wade through the pages and pages of benefit information which slows down registration, creates errors and can delay claim payment.

With Revenue360, insurance eligibility is verified for every patient, every time – improving hospital cash flow & AR days

Get the Revenue360 270/271 Eligibility Verification Payer List


Revenue360 integrates with any Hospital Information System, including:

 

 Key Advantages of the Revenue360 Eligibility Module.

Eligibility Verification Advantages For:

Eligibility is often not verified until after the initial patient visit. Without real-time verification while the patient is present, your organization cannot determine and collect co-pays and deductibles at the point-of-service. Revenue360® Eligibility Verificatio n module launches a 270 and returns a 271 at patient admission, pre-admission and/or scheduling without the registrar ever leaving the registration system, or requiring the user to re-key patient information. The result? Reduction of claim denials, decreased A/R days, decreased costs for researching problems and re-submission of claims/bills, and increased front-end collections.

You want your staff to verifiy eligibility on every patient. In order to obtain accurate information, eligibility requests need to be real-time and responses customized so registars only need to view benefit data essential to that visit. How can you ensure that your staff is complying with these requirements?

Revenue360® Eligibility Verification module initiates a real-time 270 eligibility inquiry during the registration process just as soon as the necessary data elements are entered and returns an easy-to-understand 271 customized response. Your staff now has the opportunity to collect co-pay and deductible amounts up front. Revenue360® Eligibility Verification reduces claim denials, shortens reimbursement time, decreases A/R days and improves staff productivity.

Eligibility accuracy is critical to successful registration.  Verifying over the phone or accessing payer websites is inefficient, and rarely happens during the point of registration. Revenue360 Eligibility Verification module launches the 270 inquiry at the earliest point in the registration process, returning a customized, easy to understand 271 response, allowing you to follow the next steps based on your facility’s rules without ever leaving your registration system.  Re-keying information?  Gone.  Waiting on the phone for verification?  Eliminated.  Verification is immediate, automatic, and real-time, freeing you up to attend to your other registration duties.
Fill out my online form.
Provider Advantage’s eligibility solution has helped us to increase upfront collections by identifying co-pays and deductibles for over ten years. Danielle Pieloch

Director of Patient Access, Robert Wood Johnson University Hospital Hamilton

Additional Benefits

  • Reduce Claim Rejections
  • Simplify and Increase POS Collections
  • Identify Medicaid Coverage for Self-Pay Patients
  • Identify & Collect on Retroactive Insurance Coverage
  • Pinpoint Correct Insurance Sequence & Payer Financial Responsibility

Learn More… Download Our Overview (PDF)

Recent Article

Related Blog Posts:

Mergers and Insurance Challenges a Top Concern for Hospitals

In 2016, will one result of insurance and healthcare systems mergers be the reduction in provider reimbursement for healthcare services? That’s what the AMA and doctors seem to fear — bean counters at the helm with more negotiating power. Meanwhile, insurers are very unhappy with exchanges — even with the government continuing to expand funding. This has led some hospitals to consider sponsoring their own insurance plans. Get ready for an interesting ride this year, when it comes to hospitals, mega mergers and insurance challenges.

read more

Hospitals and Point of Service Solutions

One of the topics we focus on for the Revenue360 blog is Consumer Driven Healthcare, and the evolution of politics, government rule changes, and market forces are continuing to make this an interesting and challenging area for hospitals across the nation. Money... read more

ACA’s Popular Narrow Networks May Shock Consumers

Narrow physician networks – networks that place limits on available hospitals and providers, usually only providing coverage for less than 25% of area physicians – are becoming increasingly common under the Affordable Care Act (ACA). Created as a cost containment strategy, consumers are often at a disadvantage under these narrow networks, due to restraints on types of providers available and limited availability of resourceful information for consumers when they are shopping for plans in the ACA marketplace.

The danger? Under these plans, customers are at risk of finding themselves with unexpected out-of-network expenses, potentially for thousands of dollars.

read more

Healthcare Insurance Mergers in 2016

When we last took a look at healthcare insurance mergers in November, we noted that healthcare costs continue to increase, and both deductibles and insurance premiums are rising significantly. We also saw some regulators resisting payer mega mergers (in addition to the AMA). Now it seems that big insurance continues to prosper, but state regulators may deal some serious blows to further merger ambitions, as the some insurers look at withdrawing from the exchange markets.

read more

Looking at Healthcare Revenue Cycle KPIs

There is one rock solid fact that every healthcare finance executive can take to the bank – the complexity of healthcare revenue cycle management is not likely to decrease any time soon. With this in mind, we review the latest intelligence on the challenges inherent to revenue cycle management and the relevant Key Performance Indicators (KPIs) that can be used to track RCM results.

read more

Updating Processes and Using IT to Improve Hospital Revenue Cycle Results

2014 set records for investments in digital health technology. The first three quarters of 2015 has already surpassed $3.3 billion, which is more than the entire 2014 year. Hospitals are learning in order to position themselves for financial growth and improve hospital revenue cycle results, certain technology needs to be upgraded and utilized, especially revenue cycle management software.

read more