The principle: upstream > downstream
Billing is downstream. If patient data and eligibility are messy, billing becomes expensive chaos.
Operator move: standardize intake as a script + checklist so quality doesn’t depend on who is working the desk.
The 90-second script (copy/paste)
- “To prevent billing delays, I’ll verify your coverage quickly and take a photo of the card.”
- “Can I confirm the subscriber name and date of birth on the policy?”
- “Is this through your employer, Medicaid, or Marketplace?”
- “Do you have a primary care physician listed on the plan?” (if relevant)
The 10 fields that prevent most rejections
| Field | Why it matters |
|---|---|
| Subscriber ID | Core match to payer eligibility |
| Group # | Plan routing |
| Relationship | Coverage rules vary |
| Subscriber DOB | Eligibility match |
| Plan name | Rules differ by plan |
| PCP/referral requirement | Prevents referral denials |
| Front/back card image | Proof + payer contacts |
| Correct patient name spelling | Rejection prevention |
| Address/ZIP | Eligibility matching |
| Consent/signature (per policy) | Policy compliance |
Eligibility workflow (simple)
- Scheduled visits: run eligibility 24–48 hours before DOS.
- Walk-ins: run at check-in when feasible.
- If eligibility fails: don’t “guess.” Ask for alternate coverage or get self-pay consent per policy.
Hack: build a “missing fields” rejection queue and require resolution within 24 hours. This prevents weeks of AR from tiny errors.
Implementation checklist (copy/paste)
- Choose the KPI you want to move.
- Implement one workflow change (SOP + checklist).
- QA sample 10 items/day for 5 days.
- Publish a 1‑page weekly report: KPI, blockers, next action.
Educational resource only — not legal/medical/billing advice.