Eligibility Verification Overview

With OptumInsight Netwerkes, clients can run real-time reports directly from the user interface and choose either real-time or batch verifications on eligibility checks. These transactions can be stored for one year and viewed at no additional cost. This clarity helps you reduce your financial risk by knowing the current general benefit information such as deductible and co-pay amount prior to services as well as details of coverage including plan type. These transactions are certified through The Center for Affordable and Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange® (CORE®).

Eligibility Verification is just one feature of OptumInsight Netwerkes, a web-based clearinghouse that provides primary and secondary electronic claims transmissions, electronic remittances, eligibility verification, claim statusing, and much more to help you supercharge your revenue cycle with faster reimbursement and compliant claims resolution.

With the Netwerkes transparent system, provider staff can see where every claim is in the transmission process at all times. In addition, this premier large provider group and hospital clearinghouse solution automates existing business processes to help you:

• Eliminate recurring errors 
• Prevent underpayments, overpayments, and denials 
• Increase auto-adjudication rates and productivity