Medical Administrative Assistant how-to
How to Verify a Patient’s Insurance Eligibility
Checking coverage before the visit protects the patient from surprise bills and the practice from denials.
Checking coverage before the visit protects the patient from surprise bills and the practice from denials. In short: open; enter; confirm, then complete the remaining steps below.
Step by step
Open the payer portal or eligibility tool in the practice management system.
Enter the member ID, date of birth and the planned date of service.
Confirm the plan is active and the provider is in network.
Note the copay, deductible remaining and coinsurance.
Check whether the service needs a referral or prior authorization.
Record the results and a reference number in the patient’s account.
Contact the patient if coverage is inactive or a balance will be due.
Safety reminders for medical administrative assistants
- Protect patient privacy: lock screens and never discuss patients in public areas
- Verify identity with two identifiers before sharing information
- Follow office procedures for aggressive or disruptive visitors
- Practice hand hygiene when handling cards, pens and clipboards
Key terms
EHR · HIPAA · PHI · Copay · Deductible · Eligibility verification: see the full medical administrative assistant glossary.