MaxCareMB

New year, new goals, same commitment to accuracy and care. Happy New Year from MaxcareMB.

Before you start submitting claims to insurance companies, the most important thing is to ensure complete and accurate verification of patient insurance eligibility and benefits.

1-Active Coverage: Confirm that the patient’s insurance is active on the date of service.
2-Plan Type & Coverage: Identify what services are covered (e.g., behavioral health, physical therapy, etc.).
3-In-Network vs. Out-of-Network: Check if the provider is in-network. If out-of-network, verify coverage and patient cost responsibility.
4-Authorization Requirements: Confirm whether prior authorization or referral is needed.
5-Copay, Coinsurance, Deductible: Understand patient responsibility to inform billing and collections.
6-Policy Limitations & Exclusions: Note any visit limits, excluded services, or frequency caps.
7-Billing Information Accuracy: Ensure that patient demographics, insurance ID, and group numbers are correctly entered.

Why This Is Critical:
1-Prevents claim denials and delays
2-Reduces rework and resubmissions
3-Ensures clean claim submission
4-Enhances cash flow and patient satisfaction

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