Patient Verification: Healthcare services are constantly evolving, and telemedicine is being used to improve them. Patients are raising several issues about insurance coverage. Because more than 55% of patients choose telemedicine, insurance companies are expanding their coverage. This allows medical centers to improve the comfort and convenience of treatment. They are prone to bogus insurance claims.
Scammers use forged or stolen identities to apply for medical benefits while using other people’s insurance information. Before support, the healthcare sector requires fast patient verification systems to confirm insurance claims. They assist healthcare facilities in driving convenience while protecting data from cyber threats. This blog discusses how to Know Your Patient solutions support the healthcare industry’s integrity by validating insurance information.
Patient Identity Verification – Steps Involved in Authentication of Insurance Claims
Patients who use insurance to pay for their care and receive reimbursement through telehealth are subject to local legal requirements and insurance company policies. However, the challenge for healthcare providers is ensuring that patient identity details are accurate and genuine due to strict legal scrutiny and high fraud risks.
Medicare providers are required to incorporate Know Your Patient solutions due to the fact that fraudsters often fly across countries to obtain treatments. Using this method, they can cross-check insurance information with global records, ensuring only the most deserving individuals receive medical assistance. The same can be said for individuals who wish to benefit from their insurance benefits without having to bear the burden of financial burdens.
Fraudsters are utilizing sophisticated techniques to exploit the changes brought by technological advancements within the medicare landscape. For instance, fake invoices and prescriptions. By camouflaging patient identities, imposters can easily avoid identifying their victims. Healthcare facilities can, however, guarantee better telehealth service allocation by utilizing AI-powered solutions. The procedure entails the following inspections:
Make Sure Patient Identity Details are Updated
Validating Personally Identifiable Information (PII) is the first step in the process of verifying patient identity and insurance claims. The use of obsolete information by someone is a fraud warning sign. Occasionally, people update their contact information but forget to update their medical records, such as changing their address or phone number.
It is also common for fraudsters to forge legitimate documents and use another’s name to obtain insurance benefits. Medicare providers need to identify patients in both scenarios to verify the information and ensure that the people who need medical care are getting it. Healthcare facilities have an advantage thanks to AI-powered solutions that automatically update data in databases.
Check the Insurance Status – Whether Active or Not
Insurance renews annually or every six months, depending on the issuers’ policies. Numbers may appear the same after receiving cards, but records may contain changes. For this reason, patient verification solutions immediately verify insurance status while validating card information to minimize hassle.
Cross-Check the Insurer Details Records
Telehealth service providers can identify patients by cross-verifying their insurance information with AI-powered mechanisms. These solutions make it possible for centers to access records, which contributes to maintaining convenience and security. Additionally, fraudsters frequently conceal documents to make their insurance claims appear legitimate. When telehealth providers have cutting-edge tools at their disposal, it is more difficult for them to verify patient identity and spot irregularities.
Medicare service providers can cross-validate insurance coverage information if they have reliable patient verification solutions in place. They can then offer therapies, buy medications, and offer other medical aid in accordance with the insurance companies policies.
Online Verification in Insurance Database Around the Globe
If people live in different areas, it is even more critical for telehealth providers to cross-check their insurance information. Because various nations have varying coverage rules, scammers frequently target jurisdictions with insufficient Know Your Patient checks.
Healthcare facilities with access to worldwide medical databases can reduce the risk of bogus claims. AI-powered systems also guarantee patient age verification so that no underage purchasers use insurance information to acquire prohibited medications. Cross-validating the following data using these services aids telemedicine service providers:
- Patient’s Name
- Date of Birth
- Insurance ID and card number
- Social Security Number
- Insurer details
To Cut it Short
Telehealth services are becoming increasingly popular, and medical insurance firms and providers are preparing to better assist patients. The reliability of coverage varies by region, accelerating specific issues like fraudsters accessing medical records illegitimately. For healthcare centers to validate insurance claims efficiently, they need to implement processes that allow them to know their patients.
Implementing AI-powered solutions allows Medicare service providers to organize seamless virtual appointments, ensure billing information security, and update medical records. Online verifying patient identity tools ultimately guarantee that the appropriate parties receive insurance benefits.