Scheduling, Eligibility Verification, and Pre-Authorization

Scheduling, Eligibility Verification, and Pre-Authorization

Scheduling, eligibility verification, pre-authorization and certifications within the $900 billion private health insurance industry can be quite daunting.


The most important factor in the success of a practice is patient flow. An office that can successfully smooth out the spikes in its schedule can see more patients more efficiently, which reduces wear and tear on office staff and physicians. Efficient patient scheduling is key to improved patient experience prior to and after the visit.

The GeBBS Patient Scheduling Service analyzes the peaks and valleys of patient flow and seasonality to manage the schedules. Capturing critical patient information while providing exceptional patient experience on call has helped our physicians reduce the overall wait time for the patients and reduce the time for new patient registration/enrollment.

The scheduling service offers exceptionally talented staff, with flexible staffing schedules to manage call flow for appointments. The seasonality factor is built into the staffing plan to ensure that we are not turning away any patients. The staffing schedule is planned in line with the seasonality and can ramp up at short notices to manage the patient flow for a superior patient experience.

Successfully managing patient flow takes thought and careful planning. It is by far one of the most challenging aspects of practice management. But when done correctly, smoothing the patient schedule will increase the capacity and efficiency of your practice without increasing your overhead.

Eligibility Verification and Pre Authorization

With the Affordable Care Act, insurance and eligibility verification is absolutely critical. Identifying patient responsibility upfront prior to the visit is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.

2009 McKinsey Quarterly survey of retail healthcare consumers showed that 52 percent of consumers would pay from $200 to $500 or more by credit or debit card when they visit a physician, if an estimate was provided at the point of care.

To avoid these problems, GeBBS provides a remotely-hosted Centralized Eligibility Unit for hospitals, faculty practice plans, PMS/EMR vendors, and billing companies. The solution consists of GeBBS staff, technology, management and expertise that delivers high-quality, cost-effective patient insurance eligibility and related services.

GeBBS Eligibility Verification Services has the potential to:

  • Improve A/R cycles (reduce A/R days)
  • Increase cash collections by reducing write-offs and denials

Eligibility and Benefits Verification

  • Receive schedules from the hospital via EDI, email or fax
  • Verify coverage on all primary and secondary (if applicable) payers by utilizing sites like WebMD, payer web sites, interactive voice response systems, and phone calls to payers
  • Contact patients to get updated insurance information
  • Provide the clients with the results, which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information, and much more

Other Optional -Related Services

  • Obtain pre-authorization number
  • Obtain referral from PCP
  • Enter/update patient demographics
  • Remind patient of POS collection requirements
  • Inform client if there is an issue with coverage or authorization
  • Process Medicaid enrollment

Get in touch with GeBBS and enhance your financial outcome