4 reasons to automate eligibility and benefits checks

By automatically checking patients' eligibility and benefits, you can reduce claim errors, mitigate labor costs and prevent revenue losses.
Operations RCM

Verifying patients’ eligibility and benefits is crucial for ensuring timely reimbursement—but it also can be cumbersome and time-consuming. Insurance is often manually verified, requiring staff to devote countless hours to data entry that could be better spent addressing patients’ needs. Even worse, manual eligibility checks can increase the likelihood of denied claims, depleting the cashflow that healthcare organizations need to run their day-to-day operations. 

Slow, error-prone eligibility and benefits workflows undoubtedly undermine healthcare organizations’ efficiency and revenue. But streamlining insurance eligibility checks isn’t about finding more people to do the work. It’s about leveraging technology to make the process faster, more accurate and easier to manage. 

By automatically verifying eligibility and benefits during check-in, healthcare organizations can confirm patients’ coverage in real time and gain immediate visibility into their financial responsibility. Better yet, automated checks can reduce claim errors and denials, helping provider groups prevent revenue losses. 

Here are four reasons healthcare organizations should automate eligibility and benefits checks. 

1. More approved claims 

Human error is unavoidable, but it can be costly: Research shows that more than half of claim denials are the result of mistakes made on the front end. And while denials are sometimes recoverable on appeal, it still costs more than $100 on average to appeal just one denied claim. 

Automated eligibility and benefits checks eliminate the risk of human error, helping provider groups avoid data-entry mistakes—and in turn, boost reimbursement. And if errors do occur, most automated tools allow staff to easily edit and resubmit 270/271 Transaction Sets. That translates into more accurate data and fewer denied claims. 

2. Significant time savings 

As the healthcare staffing crisis rages on, operational efficiency is more important than ever. Provider groups want to make the most of their staff’s time—but eligibility and benefits checks can be unreasonably labor-intensive. If front-office personnel are swamped with manual work, how will they have time to focus on patients and tasks that require more complex problem-solving skills? 

Technology solves that problem by helping administrative staff spend less time verifying patients’ coverage. In fact, a CAQH report found that medical providers could save 21 minutes per transaction by electronically verifying eligibility and benefits. Digital tools also allow staff to run checks during patient intake for various service type codes and easily flag patients’ primary, secondary and specialty insurance, helping the organization gain a more complete picture of its eligibility and benefits workflows. 

3. Lower labor costs 

According to CAQH estimates, healthcare organizations spend more than $5 in labor costs each time they manually check patients’ eligibility and benefits. Given the rate at which labor expenses are rising, are manual checks really worth that investment? Or would it make more sense to reallocate staffing dollars toward higher-value priorities? 

With automation, healthcare organizations can minimize the hard costs associated with checking patients’ coverage, giving them more financial flexibility to address their evolving operational needs. Better yet, automated checks provide real-time verification for complex appointment types—such as those covered by both primary and secondary insurance, or those involving services reimbursed by multiple plans—so staff members don’t have to toggle between multiple payer portals to confirm patients’ eligibility. 

In fact, if every healthcare organization in the U.S. switched to electronic eligibility checks today, the medical industry could save $9.8 billion per year. The end results are more revenue, higher front-office efficiency and a better work experience for staff. 

4. Better transparency 

Patients want to be aware of their financial responsibility, but health insurance can be difficult to understand. In fact, nearly half of Americans don’t know what a copay or a deductible is, and nearly three-quarters misunderstand coinsurance. If healthcare staff can’t tell those patients what they will owe upfront, they may delay needed care or skip it entirely. 

With automated eligibility and benefits checks, healthcare organizations can gain immediate visibility into patients’ copay, deductible and out-of-pocket obligations. That means staff can educate patients about what they will owe before they enter the exam room, and patients can rest assured that they fully understand the upfront cost of their care.  

Learn how Phreesia can help you verify patients’ eligibility and benefits in real time with automated, unlimited E&B checks.