What is Real-Time Eligibility?

Historically, when a patient with insurance came into a medical office, the staff obtained a copy of the insurance card and, if there was time, they made a call to the insurance company for eligibility status, benefits, and stop-loss information. Today, medical technology is all about networking with other systems in order to save time and increase billing success. Real-time eligibility increases staff efficiency and affords us the most accurate up-to-date patient data by performing payer inquiries online.

Real-time eligibility verification streamlines the patient intake process. In Iridium Suite for example, Real-Time Eligibility is able to verify patient insurance coverage before a patient comes through the door. Personnel can use the payer’s eligibility response to auto-generate accurate patient demographics, thus removing the need to re-key patient information and eliminating possible errors in data entry.

Real-time eligibility information returns not only the effective start and end dates of the patient’s policy, but also provides detailed benefit information with important co-pay and deductible status. Thus, we aren’t relying on what the patient can remember about their benefit plan or which out-of-pocket costs have been met in other offices. We can know in many cases what the patient’s out-of-pocket cost will be for the visit, enabling the accurate collection of fees up-front.

real-time eligibility response

Using real-time eligibility, billers won’t receive claims denials for eligibility anymore, which is very costly in both time and money. The biller who receives eligibility denials has to phone the patient or the insurance company, make adjustments to demographic and insurance data, re-submit claims, and potentially wait another 30 days for the insurance company to re-process. In this day and age, there is no reason to go through all that angst!

Setting up real-time eligibility in Iridium Suite is fast and painless, requiring only a few steps. It saves the busy medical practice hundreds of dollars and hours by averting eligibility errors. Real-time eligibility is worth the effort to implement.