Study: Eligibility verification boosts paid accounts

A new study suggests that providers who routinely verify patient insurance eligibility and benefits see higher rates of paid accounts--and that invalid patient matches scuttle many attempts at electronic validation. The study, sponsored by the California HealthCare Foundation and conducted by health plan and trade group alliance CAQH, found that missing and invalid insurance member ID numbers tend to significantly limit the extent to which providers verify insurance eligibility. That's the case despite the fact that the provider could almost always use a patient name to help identify the patient, researchers noted.

It also notes that if providers do richer searches, such as using member names and dates of birth, they could improve the validation rate of HIPAA 270/271 transactions even if patient ID numbers are missing. They cite one case, for example, of a health plan that made 500,000 matches in a month without member IDs, making life much easier for both the plan and providers.

To learn more about the study:
- read this CAQH release (.pdf)