How To: Set Up Insurance Verification
Setting up your configuration for Insurance Verification is fairly straightforward. You’ll decide how often to verify your patients and what to check in each verification, then link all of the insurances you accept.
When you first visit the RCM module in your Adit platform, you may see a welcome page that tells you more about the feature and invites you to schedule a demo. If you still see this page, your account has not yet been upgraded to include the Insurance Verification service, and you’ll need to speak with a member of our team.
Practice Information
Once you have successfully upgraded your account, the RCM page will ask you for some basic details about your practice. This information will only be used by our verification team to verify your patients’ insurance coverage. Fill out the required information, then click Next.
Throughout these configuration steps, you can also click the Back button at the bottom of the page to go back to the previous screen, or click Cancel to exit the setup process.
Verification Settings
The next page will allow you to decide when, how, and how often to verify your patients.
Trigger Settings is where you will set how long before an appointment we should trigger the verification process. You can select 2, 3, 4, or 5 calendar days or 1 calendar week before the appointment.
Verification Frequency is where you will tells us how often to re-verify a returning patient. We will only trigger a verification if it has been at least this long since the patient was last verfied in Adit, regardless of what type of verification they last had.
EHR/PMS Settings is where you can decide how Adit writes the results of each verification back to the patient’s file in your EHR/PMS. We can attach a PDF of the verification results, post a note to the patient notes, or do both. If you choose to have us add a note, you can also specify a template or format for us to use for those notes.
When you’ve finished setting your preferences, click Next.
Advanced and Basic Eligibility
The next two pages are similar to each other, but there are key differences between the function of Advanced Eligibility Verification and Basic Eligibility Verification. Advanced Eligibility is the initial verification required to verify coverage amounts for a patient’s first visit in a calendar year, for new patients, and for patients who have changed insurance since their last visit. Basic Eligibility is a re-check of a patient’s insurance benefits on subsequent visits in the same calendar year as long as they have not changed insurance. For more information, please see this article.
On these two pages, you will select which treatment codes Adit will verify when performing Advanced and Basic verifications. These choices also determine how much you are charged for each verification. You can read more about how we bill for verifications in our Guide to Insurance Verification Charges.
Every treatment code has between 1 and 4 questions associated with it. These questions are specific to how insurance views each treatment, and they ask for information like:
- Is this treatment covered? What percentage of this treatment is covered?
- Is there an age limit to cover this treatment?
- How frequently is this treatment covered?
- Is this patient eligible for this treatment? If not, when will they be eligible again?
On the Advanced Eligibility page, you will select which treatment codes Adit should verify when we do an Advanced Eligibility Verification for a patient’s first visit in a calendar year or with new insurance. Check the box beside the treatment codes in the left panel that you would like to add, then click the > arrow to move those codes into the right panel. To remove a treatment code, check the box beside it in the right panel and click the < arrow to remove it.
As you add treatment codes to the right panel, we will calculate the total number of questions associated with those treatment codes and use that number to automatically select your pricing tier from the four available options. These tiers are based on the number of questions verified, not the number of treatment codes. The more questions our team needs to ask, the higher the cost per verification.
On the Basic Eligibility page, you’ll do the same thing - select which treatment codes Adit should verify when we do a Basic Eligibility Verification on a patient’s subsequent visits on the same insurance in the same calendar year. Adit will again calculate the total number of questions associated with those treatment codes and use that to automaticallhy select your pricing tier from the two avaialble options.
Once you are happy with your choices, click Next to continue.
Verification Requests
On this page, you can give Adit permission to send an automated email or text message to your patients when we are missing any of their insurance information. You can set the content of the automated email and text messages, and we will automatically include a link to a form that the patient will need to fill out and submit.
This automated message is used only when Adit is unable to attempt a verification because we do not have sufficient information from the patient's file in your PMS/EHR software. You can also choose to send the Verification Request text message manually at any time using the QuickText menu at the top of your Adit dashboard.
Once you have set your preferences, click Next.
Insurance Info
This page contains a master list of insurance companies. In order for us to perform verifications for your practice, we need your login information for each insurance company’s provider portal. Click the Add button beside an insurance that you accept and enter your login and password for that provider portal, then click Save. Repeat for all of the insurances that your office accepts.
Adit will only verify patients with insurances that you have provided valid login credentials for. If your login or password changes, be sure to update it in your RCM preferences to ensure no delays in your verifications for patients with that insurance.
Insurance Mapping
The final page of your Insurance Verification setup is also about insurance. Here, you will see a list of all of the insurance names that you have listed in your EHR/PMS. You will need to map each of those to an insurance from Adit’s master list using the dropdown beside each name. We require this as a way to standardize insurance information in the RCM module and throughout the Adit platform.
For example, you may have an insurance in your EHR/PMS abbreviated as BCBSTX, but our master list uses the full name, Blue Cross Blue Shield of Texas. You’ll see your version, BCBSTX, on the left side of each column; in the dropdown beside it, select the matching option (Blue Cross Blue Shield of Texas) from Adit’s master insurance list.
Adit is unable to verify any insurance that is not mapped to an option in our master list.
When you complete this final step, click Finish.
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