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!

A Client's Insurance Coverage

You can manage insurance coverage of a specific client (or client's contact) via their Insurance Coverage page. This is accessed using the View Insurance contact menu option on the client journey.

All Insurance Coverage

You can also find the insurance coverage of your clients listed in Doulado's Billing > Insurance page.

Capturing Insurance Information via Lead Form

When creating or editing the relevant lead form, add the Insurance item. Take care to fill out the Label, Required, and Map To as needed.

When a client fills out the Insurance item on their lead form, the captured information will be added to their coverage.

Verifying Eligibility

You can verify a client's insurance, using the Verify button on their plan.

Selecting the Eligible status will immediately set the client's insurance coverage to Verified.

If you are enrolled for eligibilty verification with that payer, you can instead select the Real-Time Check option to prompt that payer to verify the insurance coverage details you have entered for your client.

Each 'Real-Time Check' Verification (whether automatic or manual) deducts $1 from your Funds Balance, detailed further in our Claims Dashboard article.

Enable automatic checks using the New Client / Insurance and 24-hours Prior to Appointment options found in your client list's Settings.

Whenever a verification is denied by the payer, the status of that plan will be set to Not Eligible and an email notification will be sent out as per your Eligibility Check Failed Notification Setting.

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.