Step 1: Requirement Analysis
The provider’s office needs to verify a patient’s insurance plan information and coverage when a patient calls to book an appointment.
This means checking whether the patient’s insurance is active, what services are covered, and any applicable copays or eligibility details.
Step 2: Health Cloud Out-of-the-Box Capability
Benefits Eligibility and Verification is the dedicated Health Cloud capability that allows provider offices and payers to verify a patient’s insurance coverage, eligibility, and benefit details in real time, either through integration with payers or using Health Cloud workflows.
Extract:
“Health Cloud offers Benefits Eligibility and Verification, enabling providers and payers to confirm a patient’s plan information and coverage eligibility, reducing the risk of denied claims and improving the patient experience.”
Administer Health Cloud – Benefits Eligibility and Verification
Step 3: Review of Options
A. Benefits Eligibility and Verification: Directly addresses insurance plan and coverage verification.
B. Intelligent Appointment Management: For scheduling, not insurance verification.
C. Utilization Management: For prior authorizations and care request reviews.
D. Identity Verification: For confirming patient identity, not insurance coverage.
