Real-Time Eligibility Checks with Automated Insurance Verification
Manual insurance verification is painful, prone to errors and causes delays to patient intake, while causing costly claim denials when done wrong. Fuse automates the entire insurance eligibility verification process at the CPT code level, eliminating errors and freeing your team to focus on patient care.
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Hours Saved
Auto-generate billing summaries and insurance verification results at the CPT code level, confirming coverage details and network status before visits while reducing administrative work and errors.
Insurance Eligibility Verification at CPT Level
Basic eligibility checks miss critical coverage details that cause claim denials. Fuse verifies benefits at the CPT code level, ensuring you know exactly what's covered for each procedure before appointments, such exact copays, coinsurance, visit limits and prior auth requirements.
Portal Checks Plus Payer Calls for Maximum Accuracy
Payer portals provide basic information, but direct calls reveal specifics like prior authorization requirements and visit limits at the CPT code level. Fuse takes a dual approach by combining both methods to deliver complete, accurate benefits verification every time.
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Network Status Confirmation
Get confirmation of network status and coverage details before appointments through automated payer phone calls. Prevent out-of-network surprises and provide patients with upfront cost clarity they can trust.
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Reduce Administrative Burden and Errors
Eliminate manual lookups and hours spent on hold with payers. Fuse handles eligibility checks automatically, reducing verification errors by up to 95% while freeing staff to focus on patients instead of paperwork.
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After a short onboarding call, we start learning your existing workflows and customize our solution to minimize disruption to your team.
Insurance Eligibility Verification at CPT Level
Basic eligibility checks miss critical coverage details that cause claim denials. Fuse verifies benefits at the CPT code level, ensuring you know exactly what's covered for each procedure before appointments, such exact copays, coinsurance, visit limits and prior auth requirements.
Portal Checks Plus Payer Calls for Maximum Accuracy
Payer portals provide basic information, but direct calls reveal specifics like prior authorization requirements and visit limits at the CPT code level. Fuse takes a dual approach by combining both methods to deliver complete, accurate benefits verification every time.
Network Status Confirmation
Get confirmation of network status and coverage details before appointments through automated payer phone calls. Prevent out-of-network surprises and provide patients with upfront cost clarity they can trust.
Reduce Administrative Burden and Errors
Eliminate manual lookups and hours spent on hold with payers. Fuse handles eligibility checks automatically, reducing verification errors by up to 95% while freeing staff to focus on patients instead of paperwork.
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FAQs
How does CPT code level verification improve accuracy?
Fuse's CPT code level verification checks benefits for each specific procedure, not just general eligibility and coverage by STC (Service Type Code). This prevents claim denials caused by missing coverage details or authorization requirements for the specific procedure. Fuse identifies the exact copays and coinsurance that a patient must pay for each procedure, which often cannot be determined on portals like Availity, pVerify or Office Ally. These platforms may only state what a specialist visit copay is and fall short of specifying the exact copay for an initial visit with a psychiatrist, or show multiple copay options.
Why combine portal checks with payer calls?
Fuse combines portal checks with payer calls because portals provide basic coverage information, but calls reveal specifics like prior authorization requirements, visit limits, and the copays and coinsurance that apply to that specific CPT code. Payer calls can also help determine whether the billing provider is seen as a specialist by the specific payer and how that classification impacts patient benefits. Fuse uses both methods to ensure complete, accurate benefits verification.
How are payer discrepancies identified and resolved?
Fuse compares portal and call results to identify inconsistencies. Discrepancies are flagged for review in Fuse's dashboard and in the summary Fuse produces for each check that can be inputted into your EHR. Discrepancies typically occur when a payer rep provides incorrect benefits information. In these instances, follow-up calls can be scheduled to clarify the correct benefit details.
Can this system identify coverage limitations?
Yes, Fuse identifies coverage limitations, prior authorization requirements, and visit limits at the CPT code level, reducing costly eligibility-related claims denials by pulling detailed benefit information from both payer portals and direct calls.
How can network status be confirmed?
Fuse uses direct verification calls to confirm network status because portal checks cannot confirm network status for most payers. While most practices have a sense of which plans they are in-network with, confirming network status for niche plans like self-insured plans run by a TPA can be difficult. Fuse's direct calls ensure there are no surprises when claims are adjudicated and patients need to be billed for rendered services.
How much time can I save by automating benefits checks?
Fuse automates the entire eligibility and benefits check process, reducing administrative time by up to 95%. Manual checks can take billing teams anywhere from 15 minutes to 2 hours depending on data complexity and payer hold times, averaging about 30 minutes. That manual work includes extracting data from the EHR, checking portals, calling payers, and adding a benefits note back to the patient account. Fuse's automation means significant time and workload savings for billing teams.
What is the financial benefit of automating benefits checks?
Fuse delivers financial benefits in three areas. First, Fuse eliminates admin overhead from manual benefits checks, which can take up to 30 minutes per patient. Second, Fuse prevents eligibility-related denials, which can account for up to 50% of all denials. These include missed prior auth requirements and billing outdated insurance for patients who recently switched employers. Third, faster checks through Fuse can increase the speed and volume of patient intake and help grow revenue. The exact dollar benefit depends on each practice and patient volume.
How does E&B verification reduce patient phone calls?
Patients typically call practices to find out if a specific service is covered and what they'll pay out of pocket. Fuse's automated E&B verification answers these questions before the appointment by checking both payer portals and making direct payer calls. This gives your front desk accurate coverage and cost information to share proactively, eliminating the back-and-forth calls that consume staff time.
Can E&B verification determine patient out-of-pocket costs for specific procedures?
Yes, Fuse calculates exact patient responsibility for each CPT code by verifying coverage status, deductible amounts, copays, and coinsurance through automated portal checks and payer calls. This includes confirming whether the patient is in or out of network, which directly affects their cost. Patients get accurate cost estimates before their appointment rather than surprises after services are rendered.
