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EDI insurance verification and eligibility cost

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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makoleg

(@makoleg)

Posts: 1

New Member

Topic starter

Hello,

We are having a lot of trouble with insurance verification/eligibility. We are running Centricity version 10. Currently considering adding EDI.

I was wondering if someone could explain how much it would cost us (3 physicians, 3 midlevel providers)? Does it cost on per verification basis or fee per month basis?

Thank you in advance,

Oleg.

Posted : October 12, 2015 8:20 am

mfornkahl

(@mfornkahl)

Posts: 132

Estimable Member

We recently inquired about this service and were quoted $.30 per transaction. We are hopeful this service will cut down on our patients trying to get by with only paying a copay when their insurance is inactive.

Posted : October 12, 2015 11:31 am

angelahunsberger

(@angelahunsberger)

Posts: 290

Reputable Member

You could ask for a flat rate per provider per month rather than a "per inquiry" price structure. I wrote a blog about this that will be coming out in the next week or so called "3 Secrets to Save on Healthcare IT Costs"! I recommend doing the flat rate for RTE.

Posted : October 20, 2015 3:38 am

angelahunsberger

(@angelahunsberger)

Posts: 290

Reputable Member

As a side note: Real Time Eligibility (aka electronic eligibility verification) sends a 270 ANSI transaction passed through the clearinghouse on to the payor. A 271 ANSI file is returned from the payor, passed through your clearinghouse and in to your PM system. The eligibility response can be viewed from the schedule, in registration, and in billing. NOTE: The information you will get is VARIED based on the payor and may be very detailed to very basic. In my experience, users STILL have to use alternate methods to verify including payor websites. However, I still think RTE is valuable and should be ONE of the many eligibility verification tools used.

Posted : October 20, 2015 3:41 am

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