Thought Leadership

New Perspectives To Improve the Credentialing Industry

Upfront Provider Enrollment Verification Can Greatly Minimize Claim Denials

As seen in Becker’s Hospital CFO: Written by Patrick Doyle, Vice President, Newport Credentialing Solutions

Insurance verification can have a significant impact on a hospital’s bottom line. This is why hospitals go to great lengths to ensure a patient’s insurance is verified well in advance of an encounter to avoid claim rejection. If the patient is not covered, the procedure is not scheduled.

Similar to when a patient does not have valid insurance and their claim is denied, a patient’s claim will also be denied if the provider is not properly enrolled with the patient’s insurance plan. Considering a provider can see easily 3-4 patients per hour on any given day, the financial impact of denied claims due to lack of provider enrollment eligibility checks can be significant. Yet despite the financial impact, upfront provider enrollment verification is rarely discussed or practiced within many healthcare organizations…
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Becker’s Hospital CFO is the original producer of this publication.

Newport Credentialing