Short Answer

Yes.

Long Answer

Yes. Failure to reverify coverage yearly has a negative impact on the FUP Department. You may not request FUP without a current, completed intake. We implemented this document requirement in late 2019.

Patient coverage can, and often does, change slightly every year. The Benefit Department should identify coverage changes before claims are submitted for the new year.

Yearly reverification of patient coverage may reveal changes to:

• Referral or authorization requirements
• Deductible and Out-of-Pocket (OOP) Max amounts
• Copay or coinsurance amounts
• Benefit maxes (visit or dollar)
• Member ID and group numbers

And you'd only know if you looked!

We need to avoid unnecessary FUP requests

Clients often request FUP when they're surprised by what they see on an EOB. EOBs should be reviewed against the patient's current, completed intake (i.e. for the year in question. For a 2021 DOS, refer to 2021 benefits).

• Missed a new referral or auth requirement? The FUP Department can't always fix this, and may lose time in the attempt.
• Did the EOB process exactly as indicated on the intake? This means we wasted time; the FUP request was unnecessary.

What to do

1. Reverify patient coverage every year before rendering treatment.
2. Read the completed intake carefully, so you're aware of any changes (including, but not limited to, auth requirements).
3. Review the EOB against the patient's completed intake.
4. Request FUP when the EOB doesn't process according to the patient's completed intake.