Verifying Mental Health Benefits with Online Portals
Over the past 5-10 years, the advent and improvement of online portals, some maintained by insurance companies and some designed to allow access to multiple payers, has brought many efficiencies for benefit verification as well as a few challenges. If you’re a psychiatrist or mental health nurse practitioner in private practice – and you’re verifying benefits yourself – this guide is designed to help you get started using online portals.
1. What Are Online Portals Used For?
Insurance portals are web-based platforms provided by insurers or third-party entities that allow providers to:
- Verify patient eligibility and coverage.
- Check claim status and retrieve EOBs.
- Submit prior authorizations for services.
- Access payer-specific guidelines and policies.
Common portals include:
- Availity: access to Blue Cross Blue Shield and several other payers
- OneHealthport (1HP): access to several Pacific Northwest payers
- Optum/UnitedHealthcare Provider Express
- Noridian (or equivalent Medicare portal in your area)
Though you can use most portals to do more than check coverage, this guide won’t go into using portals for requesting an authorization, submitting claims, or retrieving EOBs.
2. How Do You Access Online Portals?
Each portal requires an account, which generally involves a registration process. For improved efficiencies, we recommend first registering for multi-access portals (like Availity and 1HP). Then supplement with single-access portals (like Provider Express) to fill in the gaps for companies you can’t access within the multi-access portals. Here’s how to get started:
- Visit the website to find the registration page.
- Provide necessary credentials (your Tax ID, NPI number, contact details).
- Assign user roles within the portal.
- Link the portal to your practice management or billing system if the platform supports integration.
3. What Coverage Details Can You Find?
When verifying benefits through an online portal, you can find a variety of details. In order to access the information, you generally need at least your client’s name, date of birth and ID number.
- Patient eligibility status: The policy’s effective date. Or termination date if not active.
- Deductible & Out of Pocket status: See amount paid and/or remaining.
- Cost Sharing: Co-payments or coinsurance amounts.
- Coverage limits: There may be session limits. Or no out of network coverage.
- Authorization requirements: See if your services need pre-approval.
We recommend making a note of the benefit details for easier reference later. You can record the information in a spreadsheet or custom form, print or take a screenshot, or write a summary in the EHR/billing software.
4. Advantages of Using Portals for Verification
- Saves Time: Faster than calling the insurance company.
- Improves Accuracy: Reduces miscommunication by providing written documentation.
Some companies like Regence BCBS require you to check benefits on Availity; talking to a human is practically unavailable. Other companies may not have a requirement to use a portal, but hold times can be prohibitively long, representatives can be trained at varying levels and more often than not the reps are off-shore which can lead to frustrating results if you don’t ask your questions effectively.
5. Challenges of Using Portals for Verification
- Missing or Inaccurate Information: Not all plans show full (or correct) benefits online.
- Learning Curve: Learning how to navigate the portal and interpret the results will take some trial and error.
Each portal is designed differently, from where and how to find information, to what’s available, to how the details are displayed, to how accurate the information is. If the benefit results are confusing or sparse, you may be able to contact the insurance company for clarity, but as noted above, that might not be an option. If not, you may need to see how claims process, then compare to the various benefits you found in the portal to create a feedback loop for yourself. The feedback can help you determine the best place in the portal to look for the most applicable benefits for the service you provide.
______________________________________
If verifying benefits is something that can improve your insurance billing, but you don’t want to do it yourself, consider outsourcing. To see if MindEase Billing might be a good fit for your psychiatric practice, click on the “Request a Discovery Call” below to get started.