Insurance and Eligibility Verification

To make the claims submission process more successful for doulas, Doulado has implemented insurance eligibility verification. Verification checks ensure that insurance information is accurate before submitting claims to reduce the amount of denials and make payment returns faster.

Insurance information can now be stored in the client profile making it easier to access when it comes time to create a claim. You can enter the information during initial account creation, manually from their existing profile, or let a lead form do the work for you!

To add insurance information in an existing profile:

1. Go to the client's overview page
2. Select the three dots next to the contact information
3. Select the View Insurance option
4. Edit an existing plan by selecting it from the list or create a new plan by selecting the New Plan button

To add insurance information to your lead forms:

1. Go to the Clients tab and select the Lead Forms button
2. Open the lead form
3. Under Insert, select the Insurance option
4. Adjust the label, requirement, and the insurance mapping
5. Tap the Save button to finalize the changes, and Save again to save the lead form

Along with the contact information, insurance information will also display on the Billing tab under the Insurance page. This is one location where you can verify the insurance eligibility.

Verifying eligibility is a process that will cost $1 per check from the account Fund Balance. For more information about your Fund Balance, please review the Claims Dashboard article. This fee will be seen whether it is done manually through the Insurance tab or automatically.

Automatic eligibility checks can be enabled by checking one or both boxes in the "settings" at the bottom right of the main client list. If these are selected, the insurance will automatically be checked when new insurance or a new client is added, and 24 hours before a scheduled event with the client. Additionally, when a client submits a lead form the attached insurance information will automatically be checked as well.

When verification fails, the assigned doula's or team owners' email will automatically be alerted of the insurance issue. Once resolved and re-added, the insurance will automatically be re-verified.

Automatic Insurance Population:

Since insurance can now be entered into the client profile, this will allow the primary insurance to automatically populate on their claims as well. Primary insurance information will populate after selecting the matching client and payer from the new claim menu.

To automatically insert insurance information:

1. Select a payer when creating a claim
2. That client must have insurance matching that payer
3. The insurance must be listed as both active for that date and marked as eligible

If these criteria are not met, you will have to manually enter the insurance information into the draft claim.