Create an Efficient Pre-verification Workflow to Improve Collections and Claims

By Blakely Roth | January 10, 2023

Capturing real-time eligibility verification at multiple patient touchpoints can significantly help your practice reduce rejected insurance claims and increase point-of-service (POS) payments. High-growth practices build a cadence around reviewing these eligibility transactions, ahead of patient appointments, to improve their ability to increase realized revenue.

Building a Reliable Pre-verification Workflow

Our clearwaveCARE team helps our customers build efficient pre-verification workflows to check their patient’s eligibility in advance of upcoming appointments, giving their staff plenty of time to follow up with patients who have insurance that needs attention. This effort reduces administrative burdens by narrowing down insurance verification tasks and providing staff with clarity around insurance challenges. With a robust approach, your staff will spend less time calling on insurance providers and more time focused on patient care. The practices we work with see on average a 65% increase in POS collections with some seeing an over 100% increase in POS collections.

See how we help clients set up these workflows and how you can take a similar approach to drive results:

1. Create automated eligibility batches

Our Implementation Consultants and Dedicated Project Managers work with our clients to set up pre-verification workflows starting with automated appointment eligibility batches.

Practices typically choose to trigger automated eligibility batches two-to-three days ahead of time, meaning on a Wednesday, staff would run an appointment search report to verify the eligibility transactions for patients coming in on Friday.

An appointment eligibility batch allows practices to automatically submit eligibility transactions a few days prior to the appointment. Primary, secondary and tertiary insurance eligibility is immediately determined and updated in real time, allowing staff to perform a review right away or later that day, once they receive a task notification.

2. Run an appointment search

Our CARE team helps practice leaders set up tasks that will notify administrative staff that it’s time to review the eligibility status of upcoming appointments. With automated insurance verification, by the time staff receives their task notification the eligibility status of each upcoming appointment will be up-to-date (i.e., step one is already complete.)

Once they receive the task, staff then run an appointment search through Clearwave for all the appointments for an upcoming date, filtering to see the eligibility status of that day’s patients.

With Clearwave’s real-time insurance eligibility software, administrative staff can see all patient insurance transactions on their dashboard. For each patient, they can quickly determine which payers are flagged as active, inactive, rejected or errored. This step spares your staff countless hours tracking down patient insurance. Instead, staff can focus their attention on the patients with insurance that was deemed inactive, rejected or errored.

3. Review eligibility updates

There are numerous reasons why insurance may be inactive, rejected or errored. Your staff must understand the issue quickly to solve insurance challenges before a patient’s appointment. With smart conflict flags and filterable settings, staff will be able to quickly review inactive, rejected, or errored insurance and determine what is causing the issue. Then, they can determine how to update patient information to ensure payment can be collected at check-in.

Reviewing eligibility can be challenging, especially for new, less experienced front-desk staff or staff that are already overworked. To make this entire process second nature for your staff ahead of even launching Clearwave, our CARE training team will ensure your administrative staff are brought up to speed on how to quickly understand insurance flags and filters.

For uninsured or underinsured patients, clearwaveCARE team members can also help your practice customize and set up a self-service pay-fee workflow to ensure these patients are shown accurate self-pay fees during check-in. If you’re a Clearwave customer, ask our support team for help with this update.

4. Solve issues and collect payment

With clear direction on what’s needed to solve insurance issues, staff can act accordingly, calling on patients or payers and uploading necessary information into Clearwave. With a majority of the work automated, administrative staff spend significantly less time reaching out to patients to collect payments after their visits.

When patients arrive at the office, they’ll be prompted to pay their correct copay right at check-in through a Clearwave kiosk, tablet, dashboard or mobile phone via a QR code. Through the Clearwave dashboard, your staff can also see any outstanding balances and copays that are due at the point of service, along with what’s already been collected at check-in for each patient.

5. Rinse and repeat

With triggers set up to notify your staff to check patient insurance eligibility ahead of time, you can continually increase collections and reduce staff burdens. To make it easier for your staff to pull reports, we encourage our clients to save these appointment searches and eligibility reports as Saved Queries. This way, instead of having to re-select their settings every day, all your staff will need to do is find the query and change their date range.

Get Strategic Guidance to Maximize the Value of Your Patient Engagement Solution

When you invest in digital tools to improve patient engagement and practice growth, ensure you’re using your solution to its full potential. It can be difficult to understand best practices when it comes to workflows, customization of patient engagement and even metrics you can target.

As a practice leader, it’s hard to prioritize time to ensure you’re getting the most from a patient engagement solution. Our goal through clearwaveCARE is to help our clients maximize the value of the solution, so you can validate the spend, increase revenue and achieve patient engagement goals.

Learn more about clearwaveCARE and how we support clients in ensuring maximum value from Clearwave.