Insurance Billing & Coverage FAQ
Questions about patient eligibility verification, prior authorizations, and out-of-network claims.
What is insurance eligibility verification?
It is the process of verifying a patient's active health insurance coverage, deductibles, co-pays, and plan benefits before they receive medical care. VOPSS performs real-time eligibility checks for every scheduled patient.
Why do claims get denied for prior authorization?
Payers require prior authorization for specific services (like advanced imaging or surgeries). If the authorization is not secured before the service is rendered, the claim is automatically denied. We manage the pre-authorization queue to prevent this.
How do you handle out-of-network insurance claims?
We verify the patient's out-of-network benefits and submit claims according to payer guidelines. We also ensure compliance with the No Surprises Act, protecting patients from unexpected out-of-network emergency bills.
What is an EOB and how does it differ from an ERA?
An EOB (Explanation of Benefits) is a paper statement sent to patients showing how a claim was processed. An ERA (Electronic Remittance Advice) is an electronic file sent to billing departments explaining the payment details, which we post automatically.
Still have questions?
Our medical billing and coding professionals are here to help. Contact us to speak with a billing expert today.