How to Verify a Patient’s Insurance Using ALT Essentials
In today’s article, I’ll be walking you through how you can verify the patient’s insurance using ALT Essentials.
ALT Essentials is a clearinghouse — it’s more like a middleman between the insurance companies and the hospitals or the providers. They have other methods of verifying the patient’s insurance. You can call the insurance company, or you can go directly to the payer’s portal, or you can as well use the ESRs, but for this article we are using ALT Essentials.
Before we start, I want to explain what insurance verification simply means. Insurance verification simply means verifying if the patient’s insurance is active and also understanding if the insurance company of the patient is going to cover their visits with your clinic. This is what you are checking, and you’re also checking a lot of other information like the co-pay, the deductible. You want to make sure that you verify all of that so that there wouldn’t be any form of surprises during billing times for your clinic.
Logging Into ALT Essentials
When you log into ALT Essentials, you are going to see the patients registration, the claims and payments, the my providers, reporting, and all of this information. ALT Essentials is not just for insurance verification — you can use it for prior authorization, for submitting of claims. Basically everything concerning the revenue cycle management can be done here using ALT Essentials.
Navigating to Eligibility and Benefits Inquiry
When you log into ALT Essentials for insurance verification, you’re going to click on Patient Registration. Once you click on Patient Registration, you’re going to see a drop-down of:
- Eligibility and Benefits Inquiry
- Authorizations and Referrals
- Patient Care Summary Inquiry
Because we are verifying the patient’s eligibility and benefits, you’re going to click on Eligibility and Benefits Inquiry.
Filling In the Required Information
When you click on Eligibility and Benefits Inquiry, you’re going to see a form. You’re going to:
- Select your organization — most times this is auto-populated for your clinic.
- Select the payer — the payer is the patient’s insurance company. When you click on the drop-down, you’re going to see a whole lot of insurance companies or payers. Select the particular payer that is attributed to this patient.
- Input provider information — you’re going to input the provider NPI, the Tax ID, the payer-assigned provider ID, and all of that.
- Input patient information — the patient’s insurance ID and their date of birth. For the patient’s relationship to subscriber, select either “self” or whatever is applicable, because sometimes the patient may be depending on a family member for their insurance.
Single Patient vs. Multiple Patients
You can also click on Multiple Patients. This means you can input up to 50 patients at once — as long as they share the same insurance company. However, it is better to process a single patient at a time, because the visit type for one patient may not be the same as another. As a medical virtual assistant, just use single patients to avoid surprises.
Provider Type and Service Information
After inputting the patient’s ID and date of birth, scroll down to provider information. Select the provider type — either institutional or professional. Whatever you select will determine the service information you’re going to input:
- The date
- The place of service (office visit, telehealth visit, etc.)
- The benefit/service type
- The procedure code
Once you fill in all this information, you simply submit — and that is it.
Understanding the Color Codes
After submitting, on the left side under history, you will see the patients you’ve submitted for. Here is what the color codes mean:
- 🟢 Green — Insurance is active (Active Coverage)
- 🟡 Yellow — There was an error during submission. Go back, correct the information, and resubmit. This is why a medical virtual assistant must be detail-oriented and pay close attention to details.
- 🔴 Red — The patient’s insurance is inactive
Reviewing the Patient’s Benefits
Insurance verification does not end when you see that the patient’s insurance is active or not. You have to review the patient’s benefits. You must know:
- The co-pay amount
- The deductible — the amount the patient must cover before the insurance company steps in
For example: if the patient’s annual deductible is $500, and they have paid $366, then $134 remains. If the patient’s visit costs $200, the patient will pay $134 first before the insurance company starts contributing.
Your duty as a medical virtual assistant is to inform the patient that they are likely to cover their visit costs if the amount is less than the remaining deductible, and that the insurance company will not contribute until that deductible is met.
Procedure Code Information
When you scroll further, you will see procedure code information. For example:
- If a patient visits a pharmacy and a specialty drug is to be administered, prior authorization is required and the patient may have a co-pay of $250 per visit. The insurance company needs to approve why that drug is being administered.
- For non-specialty drugs, no authorization is required.
You’re also checking the co-pays and co-insurance for each applicable service.
Conclusion
That is basically how you verify a patient’s insurance. You are not just checking whether the insurance is active — you are also checking all the detailed information attached to it.
Please note that ALT Essentials does not support free trial accounts, and you cannot use it to verify patient insurance unless you are a provider networked with that particular insurance company.
I hope this article gives you useful insight about insurance verification. If you have any questions, feel free to leave them in the comments section.