Check Patient Eligibility for Wellness Visits for Best Reimbursement

Check Patient Eligibility for Wellness Visits for Best Reimbursement


What can you do if another provider bills for a service you are to give without your knowledge? If this claim is denied, how will you get paid? The short answer is that the certain benefits are only payable when provided under specific instances. The best thing to do is to check eligibility prior to performing a service.

Medicare Patients

For Medicare patients, you can login to the Centers for Medicare and Medicaid (CMS) website to verify eligibility. However, this will depend on the region where services are provided. The options for this include WPS Medicare C-Snap Registration, Palmetto GBA or a Medicare home page specific to your region. Providers simply must follow instructions to get login credential as a provider, or an office staff member can obtain these on behalf of the provider.

Providers who see Medicare patients should check with the carrier before the office visit, because coverage under a Medicare Managed Care Plan is sometimes confusing. Medicare patients often do not realize they are enrolled in one of these plans, and assume they are under regular Medicare. To avoid delays in payment or a denied claim, it is best to check with the patient to see if the insurance information is correct.

WPS Medicare C-SNAP

The Wisconsin Physicians Service (WPS) Medicare eligibility portal is called CMS Secure Net Access Portal (C-SNAP). The login page on C-SNAP lists various services and utilities that are available, such as:

  • Providing claim status in real-time. You can receive detailed information regarding a claim status, pending claims, and processed claims.
  • Offering the ability to submit a request to reopen, redetermine, or check the status of a previous request using C-SNAP.
  • Enter a Medicare Part B claim for IL, MI, MN, or WI. However, this service does not accept Purchased Service, MSP, or Medigap claims.
  • Give duplicate remittance advices, so you can instantly view and print the entire remittance at the office.
  • Request clarifications on claim denials or policies.
  • View responses using the online messaging system.

New or Returning Patients

Usually, when a new or returning patient comes into the healthcare facility, he or she brings an insurance card. The front office staff member is responsible for checking this and verifying with the insurance carrier to ensure the information on the card is up to date and accurate. This can be done by visiting the insurance company’s website or calling to speak with a representative. Many practice management systems and clearinghouses can verify patient eligibility as well.

The primary care provider is often interested in whether or not the insurance is in effect at the time of service. The co-pay, deductible, or coinsurance for the visit is the patient’s responsibility. A specialist, such as a cardiologist or neurologist, must check to see if the visit will be covered and verify if services require preauthorization or a referral. Either provider, specialist or primary care, must find out if they are in or out of network with the insurance carrier, as benefits will vary depending on their status.

New patient appointments are set up in advance at most offices. The insurance information is typically reviewed beforehand. This allows the office staff time to verify information before the patient is seen. Knowing what the patient’s financial responsibility is before he or she is seen will prevent any surprise or problems during the encounter. Many offices have a checklist or form that is used at the time of the visit. Some items that should be on this checklist include:

  • Patient name
  • Date of birth
  • Social security number
  • Address
  • Insurance carrier identification number
  • Insurance carrier group number
  • Is there a deductible?
  • Is authorization required?
  • Is a referral required?
  • Is provider in the network?
  • Address for claims submission
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