The "Clean Claim" Front Office Checklist

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Real-Time Eligibility (RTE): Confirm active coverage within 48–72 hours of the visit, ensuring proper insurance eligibility verification, not just at scheduling. Primary/Secondary Coordination: Identify which insurance is primary to avoid 'Coordination of Benefits' denials and maintain a clean claim checklist. Prior Authorization: Secure authorization numbers for specialized services before the patient appointment verification to ensure a smooth process.

Dual Identifier Match: Verify the patient's name and date of birth against the government-issued ID to prevent demographic mismatches during insurance eligibility verification. Demographic Verification: It is crucial to conduct this at every visit; unfortunately, 75% of practices fail to re-verify on subsequent visits, impacting patient appointment verification. Financial Policy: Ensure that a signed financial agreement and HIPAA notice are on file as part of your clean claim checklist.

Cost Estimations: Utilize transparency tools to provide patients with an out-of-pocket estimate before treatment, ensuring a thorough insurance eligibility verification. Point-of-Service Collection: Collect co-pays and outstanding balances at check-in; successful collection drops significantly once a patient leaves, making a clean claim checklist essential for effective follow-up. Additionally, patient appointment verification can help streamline this process.