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These are keys to avoiding claim denials and improving patient and client satisfaction.

Verification of patients' and clients' insurance coverage eligibility by health care providers is all too frequently neglected, resulting in claims denials for billing errors such as missing information, submission of duplicate forms, and provision of unauthorized treatment or services. At the same time, changes in the health care environment are driving the need for seamless verification of eligibility and benefits, given such forces as Affordable Care Act (ACA) marketplaces and health care pricing transparency, and the ever-present threat of identity theft.

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  1. Centers for Medicare and Medicaid Services. HIPAA Eligibility Transaction System (HETS) Health Care Benefit Inquiry and Response (270/271) 5010 Companion Guide Final. https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/Downloads/HETS270271CompanionGuide5010.pdf. Accessed November 10, 2015.
  2. Council for Affordable Quality Healthcare. Operating Rules Mandate: ACA Federal Mandate for Healthcare Operating Rules. http://www.caqh.org/core/operating-rules-mandate. Accessed November 10, 2015.

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