Benefit verification is an essential step in insurance billing. Upon request, Acubiller researches insurance coverage for our clients.

 

This process clarifies a patient's coverage, and thereby a provider's eligibility to treat the patient and any patient responsibility that may apply.

It also gives us a chance to review filing requirements with the carrier.

 

How to send a benefit request

You may submit benefit requests to our team at [email protected]

 

We use a proprietary intake form to collect benefit information from our clients. [see also "How to Read Our Intake Form"] This form is received during our onboarding process.

The intake must include the following patient information:

• full (legal) name
• full address (as on file with the insurance carrier)
• date of birth
• insurance ID (or claim number)
• sex
• Subscriber on the policy if different and their Name, DOB and the relationship to the insured.
• Contact Phone number for the insurance carrier (typically under provider services).

Follow all instructions and heed all notices indicated on the intake form.

 

Our forms are for your use only. Do not send them to patients, other providers, or any other person.

 

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Frequently Asked Questions

What information do you collect on benefit calls?

During the verification process, we research coverage for...

• Acupuncture providers: Acupuncture (needle therapy), as well as exams (office visits) and physical medicine modalities rendered by an acupuncturist.
• Behavioral Health providers: Mental health and substance use disorder.

We review carrier filing requirements, such as:

• Accepted and preferred methods of claim submission (e-claims, mail, fax)
• General Referral and authorization requirements (we recommend also having the patient check to see if these are needed for treatment)
• Additional documentation requirements (SOAP notes, treatment plans)
• Diagnosis restrictions or exclusions noted on the plan (these may be delineated on carrier authorization forms)

 

Conformity to filing requirements has a significant impact on the outcome of claim submissions. Review patient intakes carefully to make sure you understand the carrier's specifications.

 

What is my network status? Am I in-network or out-of-network?

We cannot accurately research your network participation (i.e. network status) during benefit verification. After many years, we've determined that Provider Services representatives are unable to report on your credentialing or network status. If you are wondering what the carrier reps say about your status with a plan, we can attempt to verify but because there's so many pieces that have to coordinate to be considered truly contracted for a plan we cannot guarantee it to be 100% accurate.  The "proof is in the pudding" as they say and final network determination will be reflected on the EOB after the claim has processed.

 

When should I send a benefit request?

The best time to research a patient's insurance coverage is prior to the patient's appointment. Check patient coverage in advance whenever possible. 

In addition, a re-review of coverage is recommended every renewal (Plan year or Calendar year according to the plan) and any time the patient has indicated that their policy or coverage information has changed.

 

How long does it take to complete a benefit request?

Under normal conditions, benefit turnaround is possible within 24 hours. If we're unable to complete the request we will notify within 24-48 hours on our current ticket status.  MVA or WC claims can take a bit longer to reach an adjuster but typically most will be completed within 48-72 hours.  

 

In 2019, our benefit team processed an average of 583 benefit requests per month.

But we experience some seasonal variation in request volume:

• in January, the busiest month of the year, we processed 1,165 benefit requests. [See also January Submission Guidelines for tips to streamline your January work requests]
• Summer is our slowest season. In June 2019, our slowest month of the year, we processed 464 benefit requests.

 

You may see delays in processing due to...

• High client request volume (most common in January)
• Long carrier hold times
• Carrier computer and phone system outages
• Request type (MVA, WC, and PIP claims typically take a bit longer)

 

Once benefits are verified, we'll send a verification of benefits back to you with the information as stated with the carrier.

 

Once treatment is complete, superbills or any supporting documentation can be sent to [email protected] 

(If on BT auths and referrals can be sent to us via this address but dates can be entered on the spreadsheet).

 

Because of the nature of insurance, ultimately the coverage and final determination on payment cannot be guaranteed and is a contract between the patient and their carrier to meet their obligations of premiums and payment. Once the claims are filed, the EOB will outline the carrier's reasoning for payment or denial, if this matches the benefits received then you'd approach the patient for any additional charges not assessed at the time of service. 

 

Claims filed but don't seem correct?  Send us a FUP request at [email protected]

Any claims filed but no response received you can send a follow up request by the 30-45 day mark after the claim has been submitted. 

Requests received before then without EOB will not be accepted.