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Best Practices for Running Insurance Eligibility Verification

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insurance eligibility verification

In today’s fast-paced healthcare environment, it is crucial for physical, occupational, and speech therapy practices to ensure smooth operations and efficient financial management. One essential aspect of this process is running insurance eligibility checks before providing services. Why? A Change Healthcare report from December 2020 shows that claim denials are rising. The leading cause? Registration and eligibility came in at 26.6% of denied claims. In addition, if you don’t verify eligibility before appointments, your client may not be covered – and may not be willing to pay out of pocket.


What Are Insurance Eligibility Checks?

Insurance eligibility checks confirm whether a patient’s insurance coverage includes the services they seek. Determining the co-pay, deductible, and coverage limits is crucial to avoid billing and payment issues and create transparency with your clients regarding their financial responsibilities.

If you’re using an EMR to run digital insurance eligibility checks, you may have to enroll with a payer for eligibility requests. Fusion offers a Payer Enrollment Template to submit a request for enrollment. This process may take 5-7 business days, so be sure to complete the process before the client’s appointment.

Struggling with insurance billing? Download our free guide to learn the ins and outs of insurance billing.


Best Practices for Running Insurance Eligibility Checks

While leveraging an EMR like Fusion can simplify your insurance eligibility check process, implementing these best practices will maximize success:

Collect Accurate Patient Information: Begin by collecting complete and accurate patient demographics, including insurance information. Use patient portals and digital intake forms to gather necessary details beforehand.

Create a Template: Sadly, verifying insurance is a tad more complicated than confirming coverage dates. That’s why we recommend creating a form or checklist you and your staff can use for every verification. Here’s a handy template you can use.

Verify Patient Eligibility Frequently: Prioritize verifying insurance eligibility before every therapy visit to ensure seamless claims submission and payment. Regular checks prevent surprises and help patients understand their responsibilities upfront.

Stay Updated with Payer Policies: Familiarize yourself with insurance providers’ policies to comprehensively understand coverage limits and documentation requirements. Regularly review payer updates to keep abreast of changes that may impact your billing practices.

Train Staff and Optimize Workflows: Educate your staff on the importance of insurance eligibility checks and train them on using your eligibility check tools effectively. Optimize workflows to include automated eligibility checks at the appropriate step to ensure consistency and efficiency.


Manual insurance eligibility verification is often inefficient, error-prone, and time-consuming. Providers need to access each portal, input client information, and wait for eligibility verification. On the other hand, automated eligibility checks eliminate the need to access multiple portals, which improves operational efficiency and allows therapists to focus on providing quality care. Fusion’s automated eligibility checks also help providers to quickly identify clients with insurance coverage, ensuring accurate claims submission and reducing the risk of claim denials due to eligibility issues. As a result, claims are more likely to be paid promptly, leading to improved cash flow.


Take the first step towards a seamless workflow and boosted revenue by requesting a demo of Fusion today. Experience the convenience and efficiency of automated eligibility checks through the power of EMR.




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