Eligibility Verification & Prior Authorization.

MEDMECS Eligibility team understand that patient are generally not aware of their cost sharing or does not know the difference between premiums, co-pay, coins, out of pocket and deductibles. Our Eligibility verification team constantly works on verifying patient eligibility information to ensure that patient has an active coverage, verifying the annual deductible, Co-pays, Co-Insurance & out of Pocket benefits & the services that are been provided are covered under patients plan. This process minimizes denials and appeals and also expedites the process of reimbursements for our providers. Our eligibility team also verifies if the services requires authorization prior to the services provided to patient & our dedicated authorization team works on getting prior authorization for our providers.

We also have a dedicated Pre authorization team who works with provider as well as insurance company to get pre authorization for services which requires authorization prior of services being rendered to the patient. The approval is based on Medical necessity, Medical appropriateness and patient’s benefit limits.