Wednesday, June 19, 2024

Responses for insurance eligibility and verification


Thank you all for all of the great and speedy responses!!
Here are most of them. Seems like the consensus is Zirmed, Navinet, and

1. Off the top of my head Availity and Navinet are two large companies of
which you could review. I use them for some of the ‘free’ verifications
they offer. I believe one, if not both of them, offers paid subscriptions
as well for access to more insurance providers.

2.I have used both ZirMed’s eligibility system and NaviNet. I currently use
and prefer Navinet. Navinet runs $25 a month for every insurance company
they have access to, which is most. I do not use it for Medicare, I prefer
the Medicare Portal. I input the deductible and out of pocket limits into
OPIE’s Insurance verification form and run a service estimate for the
Lcodes that had been selected. (I have most of the common insurance
company’s fees schedules in the system) Then create a Financial
Responsibility form in OPIE to show what the patient would owe. I collect
half of what their out of pocket will be after Eval and the other half at
delivery (I re run numbers right before delivery to make sure nothing has
changed; I do not want to have to refund them after claim processes).

3.If they need to break it into more payments then I do that, but I put it
in writing on my Financial Form and have the patient sign what we have
agreed to. We use Square for patient CC payments and we also offer Care
Credit 0% financing. Care Credit has been great for increasing up from
collections and not having to bill patients each month. They get 0% with
Care Credit, and I get paid at time of service from Care Credit. No monthly
billing for the patients, they pay Care Credit each month.

4.I believe my staff uses

They have most of the major insurance companies all in one place.
I also set them up for the CMS portal (myCGS for region C).

5.I think you’ll find that everyone else is doing what you are doing. I’d
be reluctant to trust a central clearinghouse anyway just because being one
step removed from the payor, their information would be less up-to-date
than the payor themselves.

6.Our practice utilizes patient verification through Zirmed for all of
patients. They also offer Patient Estimation and Patient Payments. All of
these services are great!

7.I believe Availity is free, it’s a great source. as is Navinet. If you
want to spend money, Zirmed is good.

8.We use Availity Web Portal. You may call Availity Client Services at
1-800-282-4548 <(800)%20282-4548> to request how your office may set up an
account. They can tell you the insurance companies they have.

I would look into Zirmed. They provide a wealth of knowledge in
eligibility. We also use them as our billing clearinghouse. They have great
logistics and reporting ability.

9.Navinet is what we use in Pennsylvania.

10.We changed clearing houses to Zirmed. We can verify eligibility, submit,
and correct claims if necessary all in one place. It takes a lot of time
and work to set it up but it’s worth it. I can also check most of my
carriers on Navinet. We are required to obtain precert requests for some
carriers through Navinet which you cannot do through Zirmed. Navinet offers
most of the common carrier searches for free and some like Medicare and
United you have to pay for.

11.Your clearinghouse should offer that service to you.

12.Availity has several companies Anthem blues cigna UHC ect

Thanks again!

Kirk R Wise LPO, CPO
Lima Brace & Limb
1000 Bellefontaine Ave
Lima, Oh 45804
[email protected]
fax 419.228.8138


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