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Eligibility Verification & Pre-Authorization

Insurance Eligibility Verification and Pre-Authorization

Revesolv is a renowned insurance eligibility verification company in the US with years of experience offering medical billing and coding services to international clients. To improve your revenue cycle and collections, use Revesolv Eligibility Verification and Pre-authorization services. We offer insurance verification services aimed at lowering claim denials and expediting reimbursement.

In the medical RCM procedure, insurance eligibility verification is crucial. Delays in payments and denials can come from failure to validate eligibility and obtain prior authorization, resulting in lower collections and revenues. The ability to determine a patient’s eligibility quickly and accurately gives healthcare professionals a comprehensive picture of the patient’s coverage, benefits, and payment obligations. Healthcare providers can file claims more effectively and improve their medical RCM processes by using eligibility verification processes. This also minimizes claim resubmissions, demographic or eligibility-related rejections, and denials, and enhances upfront collections, all of which lead to higher patient satisfaction.

If you find that confirming insurance claims is taking up a lot of time and resources that could be better used elsewhere, outsourcing your insurance verification services to us could be the perfect solution. With us, you can make use of our medical insurance experts’ skills and experience to streamline and strengthen your insurance eligibility verification process.


Pre-Authorization Services

As part of our Pre-Authorization services, we assist you in obtaining prior approval from the insurance company for a service, resulting in timely payment and fewer denials. Our medical billing staff receives Pre-Authorization on behalf of any healthcare organization, allowing your front desk to focus on other tasks. Our experts can assist you in the following areas:

  • Obtaining pre-authorization approval from the appropriate care management department.
  • Make the request on the client’s behalf.
  • Describe the medical necessity in detail.
  • Obtain Prior authorization in a short amount of time.
  • Prior to the patient’s appointment, report the granted and rejected authorization information.


Pre-Verification Services

Insurance Verification is the first step once the patient has been scheduled for an appointment. This procedure is the most effective way to reduce payer denials and enhance revenue. We give real-time validation of a patient’s health insurance at Revesolv. To find coverage benefits, our highly skilled specialists work diligently with patients, health organizations, and health insurance providers. Prior to the service being delivered, all of the patient’s information is validated. The dedicated eligibility verification team verifies the patient’s insurance coverage and determines what payment the patient and insurance companies can expect.


Pre-certification Process

Our staff can help you with the following as part of our pre-certification process:

  • Obtain the required pre-certification number for a procedure, visit, or other therapy.
  • After the forms are submitted online or through a web portal, follow up until authorization is granted.
  • Complete or fill out all of the necessary criteria sheets and forms.
  • If necessary, do additional steps or finish the papers.
  • To gain approval for your authorization request, contact the insurance companies on behalf of the physician.


To Revesolv Accelerate Your Billing Process, and Outsource Pre-Authorization Services.

Revesolv understands that you need to be compensated for the services you give. You won’t have to worry about this if you outsource your Insurance Eligibility Verifications and Pre-Authorization services to us. Our knowledgeable staff can assist you in speeding up your billing procedure so you can get paid faster.

Our dependable pre-authorization services have been serving the different needs of healthcare organizations as a pre-authorization company. Our team compiles all pertinent information about procedures and promptly contacts payers to acquire pre-authorization. Before submitting the request, our medical billing specialists double-check that all required evidence is included, such as a letter of medical necessity, a payer-specific prior authorization form, patient medical records, medical history, and other information requested by the payer.


You can gain the following benefits by outsourcing insurance verification and pre-authorization services to Revesolv:

  • An increase in the number of claims that were found to be clean.
  • Coverage errors are now less common.
  • Decreased rejects and denials based on demographics and eligibility.
  • The percentage of people who pass the first time has gone up.
  • Collected more money out of advance.
  • There are fewer resubmissions of claims.
  • Operational costs are significantly reduced.
  • Self-payment collections have increased.
  • There are no annual contracts that are longer than one year.
  • Patient happiness has improved.
  • Cash flow is optimized.


Benefits of Insurance Eligibility Verifications and Pre-Authorizations for Businesses

The first and most important stage in the overall medical RCM process is to verify insurance eligibility. Medical claims are frequently refused or delayed by insurance companies, owing to erroneous or insufficient coverage details provided by patients during their consultations. Denials can also be the result of the hospital or administrative personnel providing inadequate coverage information, causing the company’s cash flow to suffer by delaying payouts.

For over two decades, Revesolv has provided timely and effective eligibility verification services to international clients. Revesolv can keep you up to date on all the latest changes in health plans and policies, and help you avoid delays and denials of insurance claims by outsourcing insurance eligibility verifications and pre-authorization services. Our cost-effective solutions will not only help you save money, but they will also allow you to focus on other important tasks and provide better care to your patients. By outsourcing insurance eligibility verification services to us, you will be able to process medical claims more rapidly and significantly enhance your cash flow.


Revesolv can help you with insurance eligibility verifications and pre-authorizations.

  • Security of insurance data
  • Services for precise verification.
  • Solutions that are both affordable and effective.
  • Scalability is not a problem.
  • Medical billing software and technology that is up to date.
  • Two decades of knowledge and expertise.
  • Timely delivery.
  • Medical billing team with extensive experience.


Verification of Insurance Eligibility/Financial Clearance Process

Step 1

Patient demographic information is obtained from the hospital or clinic or directly from the patient.


Step 2

After receiving the information, our team double-checks the patient’s information with the insurance company. Verification of payment benefits, co-pays, co-insurance, deductibles, claims mailing address, referrals, and pre-authorizations, as well as particular coverage, are all included.


Step 3

Finally, we assess whether any pre-certification or authorization is required, as well as how to communicate with the payer to obtain the information needed to update patient accounts and complete paperwork.

We Provide Insurance Eligibility Verification Services

Our medical BPO team consists of the most qualified and talented insurance specialists who can assist with insurance eligibility verifications and pre-authorizations. Pre-certification and Insurance Verification services include the following:

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Health Insurance Document Checking

We thoroughly review and verify all essential documents after obtaining them from your healthcare organization before the planned session. Revesolv assembles the paperwork and arranges it in the order required by the insurance provider after examining all essential documents.

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Verification of Insurance Verification

Our RCM specialists double-check insurance E&B and coverage information with primary and secondary payers. We update the patient notes with necessary information such as co-insurance, copay, deductible, PCP name matching, in-network, and out-of-network benefits.

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Patient Follow-up

As part of our service process check, our team actively follows up with patients and contacts them to correct or fill in any missing information. This allows us to maintain track of and double-check all relevant data and documents prior to final submission.