Verification & Prior Authorization for Health Plan Coverage

With rising labor cost and decreasing insurance reimbursement, practices cannot afford to lose money on unpaid claims. A major safeguard to successful Revenue Cycle Management (RCM) is accurate insurance coverage verification. In order to do accurate  coverage verification, the following guidelines are very helpful.


Verification of insurance benefits is one of the most important parts of the billing cycle. It needs to be done before patient receives treatment. In today’s ever changing health care environment, a thorough understanding of Insurance verification process is the key to successful billing.

Scheduling Appointments

Patient care starts with the first phone call received by the doctor’s office. During creation of  appointment, care must be taken to ensure correct spelling of patient’s name, correct date of birth, contact information, and detailed insurance information. Any incorrect information at the time of scheduling will lead to incorrect verification and claim rejection. It is a good practice to get two or more phone numbers, in case  patient cannot be contacted. We recommend getting patient’s email address and emergency contact number as well.

Coverage Verification

This is the most time-consuming part of the billing process. Incorrect verification is directly linked with higher claim rejections. Verification can be done through provider's clearing house, insurance portals, and also by directly calling insurances. When there is any doubt with online or automated information, we always call insurance for clarification. At the time of verification, the minimum information needed is Co-Pay, Co-Insurance, Deductible, and Out-of-Pocket maximum. Also required is Referral information and Pre-Authorization information for procedures and tests.

Insurance Verification by FCbilling

Our highly trained and dedicated verification team is your practice’s safeguard to claim denials, costly write-offs, and high insurance outstanding. In addition to health coverage verification, our services includes referral review,  prior-authorization, and pre-determination services as well.

We document verification details directly into practice software with information such as insurance portal findings, call reference numbers, referrals, authorizations, co-pays, co-insurance, and all other needed details. We complete coverage verification before patients come in to see the doctor to facilitate smooth patient processing. Well-informed staff and well-informed patients are a formula for success.


Why choose FCbilling

Benefits of Insurance Verification

Efficient eligibility verification is a tool for increasing practice earning.

insurance verification services

Why Do Insurances Require Prior Authorization?

There are many different insurance and health plans available in each state and new ones are coming in the market frequently, all with different levels of benefits. Medical offices need to determine the type of insurance a patient has and the coverage it offers. Good understandings of coverage will aide providers in creating treatment plans with minimum burden to patients. It is important to keep patients in the loop as well, in order to keep them informed about their health coverage. Treating patients without verification of coverage might result in claim denial or unexpected medical costs transferred to patients. 

Our Distinct Pre-Authorization Service

Our Pre-Authorization team helps doctors obtain insurance approval for medical services, drugs, or durable goods before servicing patients. Each insurance plan has its own pre-authorization policy. The determination for need of pre-authorization has to be made at the time of verification. If services are provided to patients without obtaining required authorization, claims will be denied and clinics will not be allowed to bill patients.

Importance of obtaining pre-authorization  – Even though pre-authorization is not a guarantee of payment, claims are confirmed not to get paid if required pre-authorization is missing.

Benefits of working with FCbilling

Healthcare professionals at FCbilling are well-versed in billing and coding. They are able to tackle all issues related to revenue cycle management.

Our claim submission process includes exam review, claim scrubbing, and ensuring proper coding of services. Our goal is to submit error free claims and bring in payments with first claim submission.

Our correct claim submission rate is 99%. Compliance safeguard is built into our billing and coding process. Our efficient billing and coding reduces refund requests and audits. We are always ready to give feedback to our providers, work with insurance on their behalf, and work with practice staff to complete the billing cycle efficiently.


prior authorization meaning in healthcare

Which Services Require Pre-Authorization

Each insurance plan is unique in its requirement for service coverage. Unless the practice is absolutely certain that pre-authorization is not required, such as traditional Medicare, biller should confirm with insurance for all high-value services. Common services which might require pre-authorization are:

define prior authorization in healthcare

Highlight of FCbilling Verification Service

FC Billing Verification and Pre-Authorization team can take care of patient processing needs for your practice. Our services are:

We are always available to answer any questions


Don’t let your practice be lost in the maze of claim rejections, non-pays, EOBs, and LCDs. Put an end to the insurance chase. Team up with our experts for outsourcing your medical billing.

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