Eligibility Verification Service - Sample Communication Spreadsheet
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First NameMiddle NameLast NameDate of BirthAddressPhone NumberPayer NamePatient's Insurance IDInsurance Group NumberVerification of correct policy number and group numberPolicy effective dates and current status of patient's policy.Type of policy and services coveredCo-payCo-insuranceDeductible and how much the patient has already satisfied in the deductible periodOut of pocket expense(Family and individual)Policy LimitationsCap visits met / not met by the patientServices that are excluded from coverage paymentPaper claim mailing address phone numberClaims adjusters name and phone numberRequirement for pre-authorization for referralsIn Network / Out of network benefitsTimely filing limitations for claim filingDocumentation requirementsDate of callInsurance Company Rep Call Reference # (Provided by the Payer)
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SuzieSmith7/16/78100 Main street201453698Aetna34983984FGSTSTT1Verified1-1-22 (Active)PT covered$2070/30$1500 ($900)$2,000NoneNot metUltrasound457-756-2848Mary Jane 546-897-5789YesNone1 yearFlowsheet required5-17Jamey340934989
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It is mandatory for the clinic to provide all the elements in green. Once provided, the Eligibility Verification team will call the payer, obtain the data points marked in yellow (within 2-6 hours in most cases), and provide the data points in yellow, by updating this spreadsheet in real time.
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If you need more data points not specifically mentioned here, please notify your sales representative, who will let you know whether or not this information can be retrieved and provided to you on a regular basis. Any requests for additional data points will incur a minimum additional cost of 50 cents per field and is subject to approval by your sales representative. Please note that additional data points may also result in increased delivery time.
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