Step 1: Requirement Analysis

The provider’s office needs to verify a patient’s insurance plan information and coverage when a patient calls to book an appointment.

This means checking whether the patient’s insurance is active, what services are covered, and any applicable copays or eligibility details.

Step 2: Health Cloud Out-of-the-Box Capability

Benefits Eligibility and Verification is the dedicated Health Cloud capability that allows provider offices and payers to verify a patient’s insurance coverage, eligibility, and benefit details in real time, either through integration with payers or using Health Cloud workflows.

Extract:

“Health Cloud offers Benefits Eligibility and Verification, enabling providers and payers to confirm a patient’s plan information and coverage eligibility, reducing the risk of denied claims and improving the patient experience.”

Administer Health Cloud – Benefits Eligibility and Verification

Step 3: Review of Options

A. Benefits Eligibility and Verification: Directly addresses insurance plan and coverage verification.

B. Intelligent Appointment Management: For scheduling, not insurance verification.

C. Utilization Management: For prior authorizations and care request reviews.

D. Identity Verification: For confirming patient identity, not insurance coverage.