Insurance and Eligibility Verification Services

According to industry data, nearly 75% of claim denials result from patients being ineligible for the services billed to insurers. This often occurs when a patient’s policy has been terminated or modified without the provider's knowledge.

At BlackRokk, we help healthcare practices reduce their accounts receivable cycle and boost revenue by minimizing the impact of ineligibility and increasing the number of "clean" claims—claims that are accurate, complete, and submitted for patients eligible for benefits. Unfortunately, eligibility verification is often one of the most overlooked components in the revenue cycle.

Without proper eligibility and benefits verification, numerous downstream issues arise, including delayed payments, increased rework, decreased patient satisfaction, heightened errors, and nonpayment. To address these challenges, BlackRokk offers a remotely hosted Centralized Eligibility Unit for hospitals and faculty practice plans. Our solution includes deploying staff, technology, and expertise to deliver high-quality, cost-effective patient insurance eligibility and related services.

Key Benefits of BlackRokk's Eligibility Verification Services

• Improved Accounts Receivable Cycle: Reduce accounts receivable days and streamline cash flow with efficient eligibility verification.
• Increased Clean Claims: Ensure a higher number of claims are submitted error-free and for eligible services, significantly reducing the risk of denials.
• Increased Cash Collections: Minimize write-offs and denials by verifying patient eligibility upfront, leading to higher cash collections.

Our Comprehensive Insurance Eligibility & Benefits Verification Services Include:

Schedule Receipt

We receive patient schedules from hospitals via EDI, email, or fax for timely processing.

Eligibility Verification

We verify coverage for all primary and secondary payers using resources such as WebMD, payer websites, automated voice responses, and direct calls to insurers.

Patient Outreach

If necessary, we contact patients to gather any missing or required information.

Detailed Eligibility Results

We provide clients with comprehensive results, including key eligibility and benefits details such as member ID, group ID, coverage start and end dates, co-pay information, and more.

Optional Related Services:

• Pre-Authorization Number Acquisition: Secure pre-authorization numbers from payers to avoid claim rejections.
• Referral Management: Obtain referrals from primary care providers when required.
• Patient Demographics Update: Enter or update patient demographic information to maintain accurate records.
• Point-of-Service (POS) Collection Reminders: Inform patients of collection requirements at the point of service.
• Coverage Issue Notifications: Notify clients of any coverage or authorization issues that may arise before care is rendered.
• Medicaid Enrollment Support: Assist patients with Medicaid enrollment to ensure eligibility and benefits coverage.

Why Insurance Eligibility Verification Matters

Eligibility verification plays a critical role in determining who can provide care, under what circumstances, and for which services. By confirming patient eligibility before treatment is rendered, we help healthcare providers reduce the need for rework on claims, avoid potential denials, and proactively inform patients of their coverage options.