Insurance Verification PROCESS

The Extremity Care Reimbursement Service verifies insurance coverage with the following information:

✔ Patient Name
✔ Patient Date of Birth
✔ Patient Insurance Plan(s) Policy number(s)
✔ Physician and Facility NPI, Tax ID, Payer IDs, PTANs
✔ Physician and Facility Network Status

We will get current status on the patient’s:
 

✔ Effective date with the plan
✔ Deductible/Deductible met
✔ Copay
✔ Coinsurance
✔ Out of Pocket/Out of Pocket Met

All the above information is then verified with the submitted:
 

✔ Diagnosis & CPT code(s)
✔ HCPCS code of the product

Prior Authorization/Pre-Determination requirements and availability for Proactive PreD if plan allows

✔ All documents needed and where to send them with Turn-Around-Time Expectations given in the summary

Verification of patient insurance plan & benefits (24-48 hour turn around)
Verification of HCPCS, Diagnosis and Application Codes
No shipment without IVR clearance

 

WHAT HAPPENS NEXT?

  • Hotline will perform the Benefits Verification and Sales Rep and Customer will receive notices upon completion.
  • Account receives all patient benefit information