Benefits verification made simple for your practice  

Working with insurance providers can make things complicated. A simple payment for treatment turns into a tricky game of “who owes what, how much, to whom?” Factors like different insurance plans, co-pays, in-network statuses, service types, and even location can affect reimbursement rates and payouts.  

Fortunately, there are some things you can do to simplify this process for you and your clients, one of which is staying on top of benefits verification. Getting this right can save you (and your clients) from unnecessary stress. Missteps during verification can lead to denied claims, surprise bills, and hours spent rechecking paperwork. But it doesn’t have to be complicated. By understanding the process and following a few simple steps, you can make benefits verification a natural and stress-free part of your workflow.  

Here’s a deeper look at what benefits verification is, why it matters, and how to simplify it with clear examples and specific tips.  

What is benefits verification?  

At its core, benefits verification is about double-checking what a client’s insurance covers. This helps you and your team confirm the following essential details before providing care: 

• Whether the insurance is active  

• If it covers the services you plan to offer  

• Whether any pre-approvals (authorizations) are needed  

• How much the client will owe (copays, deductibles, etc.)  

For example, imagine a therapy client comes into your practice and says they have insurance coverage for sessions. If you don’t take the time to verify their benefits, you may not realize that their deductible hasn’t been met, or they require prior authorization for reimbursement. This could delay payments and create confusion for the client.  

Gathering these details before treatment begins prevents billing surprises and keeps your systems running more efficiently.  

Why benefits verification matters for your practice  

Skipping the verification step can have ripple effects that impact your practice’s revenue, your team’s workload, and your clients’ trust. Here’s why this process is so important.  

Reduces denied claims  

Claims can be denied for many reasons, but one of the top culprits is failing to confirm insurance details upfront. According to industry stats, up to 75% of denied claims are avoidable. With proper verification, you minimize rejections and avoid the time-consuming task of appealing denials or resubmitting claims.  

Builds trust with your clients  

No one likes surprises when it comes to health care costs. Verifying benefits helps you give clients a clear estimate of their financial responsibilities from the start. This builds trust and demonstrates that you’re looking out for them, not just through therapy or rehabilitation, but in their overall experience with your practice.  

Simplifies your operations  

When you handle benefits verification early and thoroughly, it helps your entire practice run more smoothly. It reduces the chances of extra administrative work like resubmitting claims or chasing overdue payments. When your systems work well, you have more time to focus on your clients.  

How to improve benefits verification in your practice  

It’s one thing to know benefits verification is important. It’s another to make it work seamlessly in your day-to-day processes. These tips break it down step-by-step so you can make it a manageable and routine part of your workflow.  

Gather all the right information upfront  

Before you provide services, make sure you have a full picture of your client’s insurance details. Add these to your intake process so it’s easy to standardize.  

Here’s a basic checklist for what to collect:  

• A scanned copy of both sides of the client’s insurance card  

• The insurance company name and contact details  

• The client’s full name, date of birth, and subscriber ID  

• Details of any secondary insurance (if applicable)  

Note: if you have a client covered under a spouse’s insurance, you’ll also want to note the policyholder’s information (e.g., the spouse’s name, employer, or birthdate). Don’t forget to also double-check for any additional documentation required, like a photo ID.  

Verify benefits before every visit  

You might assume, “I checked their insurance last month, we’re good.” Unfortunately, coverage details can change quickly. Clients may switch employers, move to a new plan, or experience adjustments to their Medicaid or state-funded insurance.  

Make it a habit to verify insurance benefits before each visit, especially if there’s a gap between scheduling and the appointment itself. For clients with Medicaid, coverage can change monthly, so it’s worth running a quick check even for regular visits.  

Example tip: If you’re seeing a client who recently moved, confirm if their address and contact information are still the same or if there have been updates. Including targeted questions like “Have you or your family recently moved or changed phone numbers?” can help ensure your records are accurate. 

Handle coordination of benefits  

Some clients have more than one form of insurance, especially if they’re covered through both their own employer and a spouse’s or parent’s plan. Understanding which insurance is billed first (the primary) and which is secondary is crucial to avoid claim denials.  

For example, if you’re working with pediatric clients, use the “birthday rule” to determine primary coverage. This rule states that the parent whose birthday falls earlier in the year provides the primary insurance. However, there are always exceptions, so make it a rule in your practice to double-check with the payer for clarification.  

Use clear intake forms and ask thoughtful questions  

Your intake forms are the first opportunity to gather essential information. Instead of asking broad questions like “Do you have insurance?” try more specific ones like, “Do you have secondary insurance coverage?” or “Has your insurance plan changed recently?”  

Clients may not always know their coverage details off the top of their heads, so ongoing communication with a mix of open-ended and detailed questions is key.  

Train your team and create a checklist  

Consistency matters when it comes to benefits verification. If your staff handles this process, make sure they know exactly what to look for and how to document it.  

Train them on common terms like “deductible,” “copay,” and “authorization.” Create a simple checklist for them to follow to ensure nothing slips through the cracks. For example, your checklist could include these steps: 

• Confirm active coverage for the date of service  

• Verify services are covered  

• Check if prior authorization is needed  

• Gather copay, deductible status, and out-of-pocket costs  

Leverage technology for efficiency  

If your practice uses an electronic health record (EHR) system, take advantage of features like batch verification. This allows you to verify benefits for multiple clients at once, saving time for you and your team.  

For smaller practices, automating regular insurance checks (especially for Medicaid clients) can make a huge difference and save a lot of time.  

Prepare for common challenges  

Even if you implement all the right systems, some hiccups are unavoidable. For example, what if a client insists they have active coverage, but you’re being told otherwise?  

When this happens: 

• Double-check your verification process for errors (e.g., wrong ID or group number).  

• Contact the payer directly to confirm coverage status.  

• Work with your client to ensure they understand how their insurance works.  

For high-deductible plans, ask clients if they’ve recently had major medical procedures, which could have affected their deductible status. This might prompt them to recall important details you wouldn’t know otherwise.  

Final thoughts  

Getting benefits verification right doesn’t just reduce denied claims and smooth out operations. It’s a way to show your clients that you’re invested in every part of their care.  

Start small. Focus on steps like improving your intake process, verifying benefits regularly, and using technology where you can. Over time, these changes will save you stress and free you to focus on helping clients.  

By prioritizing benefits verification, you’re creating a more efficient and client-centered practice. It’s a win-win for everyone involved.