Which term describes the process of verifying a patient's insurance coverage before services are rendered?

The process of verifying a patient's insurance coverage before services are rendered is known as eligibility verification. This term specifically refers to the steps taken to confirm that a patient's insurance policy is active and that the services they will receive are covered under that policy. It typically involves checking the patient's details with the insurance provider to understand what benefits are available to the patient at the time of service, which ensures that the healthcare provider is informed of the patient’s coverage limitations or requirements.

Other terms might sound similar but serve distinct purposes. For instance, pre-authorization is a process that often requires a provider to obtain approval from the insurer before performing certain procedures or treatments, assuring that they will be reimbursed. Pre-certification refers to the authorization required for certain services, which may include pre-authorization but usually involves a specific process for inpatient admissions or extensive medical procedures. Claim submission pertains to the process of sending a bill to the insurance company after services have been provided, which is a separate step from verifying eligibility.