What is Multi-Factor Insurance Eligibility Verification?  

By Blakely Roth | January 24, 2024

How your staff determines patient responsibility and insurance benefits plays a large role in point-of-service collections, bad debt and patient payment transparency.   

Rather you’re using an automated tool for patient insurance verification, or this responsibility sits on your staff’s shoulders — see how a solution that offers multi-factor eligibility™ verification can help you increase revenue. 

What exactly is multi-factor eligibility verification? First, understand where manual insurance verification and traditional automated solutions fall short. After all, while you may have automated part of the process or feel confident in your staff, see where collections can fall through the cracks. 

How does traditional patient insurance verification impact collections?

Traditionally, practices rely on billing and administrative staff to verify patient insurance, benefits and co-pays. To do this, they must call insurance companies or patients to check benefits, sift through large packets of information, search on payer websites, answer questions from insurers and patients and reconcile any discrepancies along the way. While manual verification workflows can work, it also introduces several challenges, including: 

• Hours of dedicated staff time, leaving less room to focus on other responsibilities. 
• Increased risk of human error, increasing claim rejections down the line. 
• Higher investment in administrative training.
• Slow check-in processes, increasing patient wait times.  
• Uncertainty about what’s owed at check-in, leading to bad debt and post-service collections challenges. 
• Inability to collect co-pays and deductibles due. 

When roadblocks like these get in the way, the insurance verification process can be a major headache and source of frustration for all involved. High-growth healthcare practices are overcoming these challenges by modernizing their approach with insurance eligibility verification software. However, without multi-factor eligibility verification, practices still face collections challenges. 

What challenges do practices face with software that doesn’t provide multi-factor verification?

There are a lot of insurance eligibility software solutions available to specialty practices, hospitals and health systems. Yet, they are not all one in the same. Without multi-factor eligibility verification, practices often only run insurance once, or in batches that are convoluted to re-run. As a result, practices face common issues like: 

• Stale data leading to claims rejections and post-service billing errors.  
• No quick or automatic way to identify patients with who’ve recently changed coverage. 
• Collecting too little or too much at check-in, leading to back-end billing challenges. 
• Higher staff intervention, rendering the ‘automated eligibility solution’ useless. 
• No clear way to highlight insurance discrepancies like other payers on file, mismatched names, or PCP. 
• No automatic matching of correct co-pay to patient accounts, causing staff to make manual updates  
• Zero ability to automatically check self-pay patients against Medicaid 

These scenarios are all too common when insurance eligibility is only run once and typically with generic rules or from singular clearing houses. When these challenges occur, staff have no choice but to intervene, spending time manually making updates and causing practices to miss out on the opportunity to collect at the time of service. This scenario puts practices right back where they started, before they invested in automated software — racking up bad debt and minimal point-of-service collections while wasting precious staff time on verification. 

Think about your cash flow. Out of all the denied claims, 65% of them are never reworked. Although some denials are corrected and eventually paid, research from Modern Healthcare estimates it costs an average of $118 per claim to recoup those funds. 

There’s a better way. 

How can practices truly capture up-to-date patient insurance verification?

When practices only run eligibility once, patient information gets stale, meaning practices either can’t collect at the point-of-service or collect the wrong amount. Then, later on in the billing cycle, the practice will also face claim rejections, due to inaccurate insurance information. Considering a patient’s propensity to pay once they leave the office drops to 30%, having a way to run eligibility multiple times, quickly and without added fees, is all imperative to increasing collections across the patient’s entire experience.   

For healthcare practices, confirming insurance coverage is key to collecting payment throughout a patient’s healthcare journey. When practices have up-to-date insurance information at the time of service, patients can pay their co-pays, deductibles and outstanding balances prior to treatment. When it comes time to bill for services performed or after a global period of care for example, being able to quickly run insurance information in real time also helps to speed up post-service payment collection. 

Multi-factor eligibility makes the difference between collections and rejections. Here’s what practice administrators need to know.

1. What is insurance multi-factor eligibility verification software?

Mult-factor insurance eligibility software runs eligibility multiple times on every patient, including on the day of service, and can drill down to the plan level — showing staff only the information relevant to them. This view is what can save staff hours in a day.  

A solution with multi-factor eligibility™ will run automatically and verify insurance at every critical patient interaction, from scheduling to check-in and beyond, all to ensure coverage has not lapsed and without added fees per transaction. As a result, your practice never has stale insurance data and can spot and correct errors faster, enabling them to collect accurate payments when a patient checks in. The same smart solution can also be used to quickly determine patient insurance information in real time for any post-service billing activities. 

After verifying the information, the solution will allow your staff to quickly see the status of the insurance and then alert the staff of discrepancies. 

For example, Clearwave’s Multi-factor Eligibility™ runs seven times on average per patient engagement and can be instantly rerun with the click of a button — enabling your practice to always collect accurate payments at the point-of-service and verify insurance information for accuracy during post-service billing. The entire process is run without added fees, meaning you don’t have to pay extra for accurate data — because why should you? 

Clearwave also automatically maps payers to appointment types, matching and inputting the correct co-pay amount to patient accounts — reducing manual errors and the need for refunds or future co-pay collection efforts. As a result, practices see immediate improvements to co-pay collection and no longer need to register at payer sites or send staff to call on patients or payers. 

2. How does it work?

A multi-factor eligibility tool should automatically verify patient insurance multiple times, rather than just once before a patient checks in. Patients input their insurance information upon scheduling an appointment and from there, multi-factor eligibility software takes over! 

For example, Clearwave’s Multi-Factor Eligibility runs automatically at multiple patient touchpoints, including scheduling, pre-check, in-office registration and more. It’s built into the workflow to run automatically at various points along the patient’s journey and each time, pulls insurance data from multiple clearing houses and more than 900 payers. 

Beyond proactive, automated insurance eligibility checks, in Clearwave, patient eligibility verification can also be re-run at any time without added fees. This approach helps practices ensure insurance accuracy for post-billing claim submissions, which is a key benefit for practices that must bill patients after the global period of care ends.  

Clearwave’s Eligibility software combines these proactive insurance checks with a real-time eligibility dashboard that provides staff with a holistic view of patient coverage details. This is where administrative staff can review patient insurance details in one centralized scheduling view, rather than toggling between multiple payer portals or patient accounts in your practice management system or electronic health record. For example, within one click in the Clearwave Dashboard, practice staff can see: 

• Remaining Deductible, Appropriate Copay – Primary Care, Specialist, Urgent Care, or Outpatient 
• Plan Name / Type 
• Data Conflict Discrepancies between patient entry and payer response 
• Managed Care / Independent Physician Association information for HMO/Medicaid plans 
• Medicare Secondary and Reason information with Coordination of Benefits Date 
• Medicare Advantage Information 
• Home Health / Hospice Health Information

3. What are the benefits?

Multi-factor eligibility verification allows practices to transform a previously burdensome process into a streamlined strategy that alleviates stress on employees, enhances patient satisfaction and boosts collections. There are many benefits to this modernized approach, but here are five in particular to consider:  

• Increase Staff Productivity & Reduce Costs: Take the burden off staff, reduce FTE’s required in your administrative processes and/or reallocate them to responsibilities that demand manual intervention. 

• Get Paid Faster: Verify what services can be provided and see co-pay amounts, deductibles and past-due balances ahead of or at the time of check-in – boosting point-of-sale collections and time to payment. 

• Reduce Claim Rejections & Resubmission Costs: Removing the manual element in the verification process mitigates the risk of human error. This switch improves the accuracy of insurance information and patient data and leads to reduced claim rejections. Clearwave’s eligibility engine has shown to drive a potential 94% decrease in insurance claim rejections! 

• Expedite Patient Check-In: By verifying primary, secondary and tertiary benefits up to seven times prior to a patient’s arrival, practices can keep check-in fast – ensuring short lines and minimal wait times. 

• Improve Financial Transparency: Patients want to know what their financial responsibility will be prior to receiving care. Practices can deliver this transparency with accurate insurance data, keeping patients happy and building loyalty.  

For a glimpse into the real-world results that Multi-Factor Eligibility™ can provide, read Southview Medical Groups’s story. 

Since implementing Clearwave, Southview has seen 91% of co-pays collected at check-in and 92% active insurance. 

See How Your Practice Benefit from Multi-Factor Eligibility Verification

Multi-factor eligibility can be your solution to drive more collections than ever before. Learn more about Clearwave’s Patient Multi-Factor Eligibility™ platform by scheduling a demo. The key to more revenue and fewer claim rejections is here, try it now! Your pockets will thank you.