Submitted on Wed, 2015-12-09
By SMART Health Claims

Simply taking 10 seconds to verify insurance coverage could make or break your flu season from a financial perspective.

The CDC reported that more than 140 million 2015-16 flu vaccines have been distributed already.

Deep into the heart of the hectic flu season, health departments are immersed in a multitude of flu-related tasks. Unfortunately, given the many responsibilities of the front office staff, checking a patient’s eligibility is just one more thing to do.

Simply taking 10 seconds to verify insurance coverage could make or break your flu season from a financial perspective.


A Changed Insurance Landscape

As the insurance landscape evolves, health departments face an increasingly complex billing and claims process. You need to manage new requirements, regulations and coding sets while juggling the need to track and organize submitted, rejected and reimbursed claims. Sounds like enough to do, right? But checking eligibility prior to treatment can save you hours of frustration and help to streamline the entire reimbursement process.

Checking Patient Eligibility: 3 Big Reasons to Take 10 Small Seconds

In no more than 10 seconds, you will receive insurance coverage details, and be able to confirm or deny active insurance coverage on the date of service, rather than after the fact. Here are 3 ways checking patient eligibility will impact your department:


  1. It Prevents the Loss of Revenue:Every flu vaccine distributed to a patient without eligibility results in revenue loss. Recouping costs for services is essential to funding all of the valuable services health departments provide throughout the year.
  2. It Prevents Claims from Being Denied: The #1 reason claims are denied is that the subscriber is not eligible at the time of service. Checking eligibility means that health departments know, in advance, that patients are properly covered and that the bill will be accepted. It gives them the ability to know exactly what they can and cannot bill and whether or not they need to collect a deductible or a co-pay from the patient. Also, taking this small step also prevents claims rejections down the road, creating a healthier bottom line.
  3. It’s More Accurate: Inaccurate patient information and submission to the wrong insurance company are the major causes of denied or rejected claims. By verifying patient and payer information prior to rendering care, claims errors can be prevented and the rate of reimbursements can be improved. By verifying that patient information is up to date and accurate, providers can also reduce the possibility of sending off claims that may be fraudulent.

Real-Time Eligibility Checking (In Just 10 Seconds)

Checking patient eligibility is more important than ever for health departments, as funding declines and costs increase. As insurance coverage becomes more complex, it’s important to have complete visibility into patient coverage.

Our real-time eligibility checker allows you to instantly check a patient’s insurance coverage online. This tool is only one piece of Upp Technology’s SMART Health Suite of billing solutions and services, which makes billing and claims management easy for local and community health professionals.

To learn more about setting up a billing process and boosting revenue, contact one of our public health consultants and set up a demo.



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