How to Verify Eligibility and Benefits for Mental Health Providers [with Scripts]

How to Verify Eligibility and Benefits for Mental Health Providers [with Scripts]

Preparing To Check Eligibility and Benefits

You’ll need to prepare a bit of information before you begin, so go make sure you’ve gathered:

Provider information..

  • Your NPI number
  • Your Tax ID or Employment Identification Number (EIN) or Social Security Number (SSN)
  • Your License number (often not needed)
  • Your service address

Patient information..

  • Address
  • Date of Birth
  • Subscriber First & Last Name
  • Subscriber ID Number
  • Insured First and Last Name
  • Insured Relationship (self, child, spouse)

Ideally you have a front and back photocopy of the subscribers insurance card and if you don’t have one, in the future, always ask!  A simple photo from your smart phone will more than suffice.

 A Simple Eligibility and Benefits Phone Call Script

Time to get on the phone and call up your favorite insurance company to verify coverage for your new patient.

The following script will help you hit all the major points but also realize most insurance reps will guide you through this process on the phone naturally.  Make sure to ask some of these extra questions as well to cover all your bases.

  1. “I’m looking to verify eligibility and benefits for a new patient for Outpatient Mental Health Provider services”
  2. “Before I begin, I want to make sure I am an in-network provider for your panel, can you please check?”
  3. “Great, and I want to verify you have the correct address for my office, it’s _________”
  4. “The subscriber ID, date of birth, and first and last name are..”
  5. “I want to confirm there are no limits or authorizations required for this patient”
  6. “I wanted to confirm the following CPT codes: 90791, 90834, 90837, 90847” (add any  other CPT codes you bill for here)
  7. “What’s the copayment or coinsurance for this patient?”
  8. “Does this patient have an outstanding deductible?”
  9. “What address should I send my claims to?”
  10. “What is the Payer ID for electronic claims?”
  11. “Thank you so much for your help, can you please provide me your name and a reference ID for this call for my records?”

Viola!  You have all the necessary information to ensure your claims will be filed successfully, where to file them, and if anything does go wrong, how to reference the call to ensure your claim will be corrected.

Make sure to write down answers to all of these questions as they will be crucial for your notes as well as for charging your new patient’s copayment in office.


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