Benefits Verification

BPS Worldwide is a third party provider for eligibility verification.  BPS Worldwide has direct and indirect contracts with different insurance companies to provide on-line eligibility information to healthcare providers.  The advantage to going through BPS Worldwide is that, as a third party vendor, our customers will have access to all companies' information.  When the terminal is dialing out, it is going through our servers directly to the insurance company's computer and checking to see if the patient is eligible for the provider’s services, as well as other information.  The insurance company, not BPS Worldwide, determines the information that comes to the healthcare provider. Different insurance companies will also provide different EOB information on the eligibility response.  Some carriers are only partially or not at all HIPAA compliant at this time. The official deadline for HIPAA compliance is October 2003.

Altogether, there are about 1500 insurance companies and HMO or PPO plans in the United States, but at this time, only around 65% of these companies and plans offer on-line BV.  Most of these, but not all, have contracted with one of several electronic distribution networks.  BPS Worldwide has contracts with all of the major networks.The key is that while on-line BV cannot be offered for all companies yet, BPS Worldwide can offer access to more companies than anyone else. 

Benefit Verification is currently a major problem for healthcare providers. BV is the part of the product that interests providers the most. Most providers either use phone calls to check eligibility, a process that is extremely time consuming, or do not bother to verify at all and take a chance that the patient is covered. Considering that the average time on the phone to check eligibility is somewhere around 20 to 40 minutes, vs. less than a minute through the BPS Worldwide terminal. Reducing time on the phone even by as little as 20, 30, or 40 percent will prove to be a significant savings of both time and money to the healthcare provider. In addition to the savings, the provider also has a hard copy of the benefit verification directly from the insurance company.  If the claim is declined saying the patient is not eligible, they now have dated and time-stamped documentation to fight for payment.

Another key feature that providers need, especially with managed care, is the confirmation of the name of the Primary Care Physician (PCP).  BPS Worldwide is able to give the provider this information along with deductible, co-pay and customizable enquiries for specific services or procedures.