Verification of Benefits (VOB)

Verifying benefits is essential in the collections process as it provides insight into expected coverage while improving claim accuracy. The VOB section of the Work Center helps users monitor prospective and admitted patients who require benefit verification. With Avea, verifying and recording a patient's benefits has never been easier!

VOB vs Eligibility

Checking a patient's eligibility and verifying their benefits have similar overall goals but involve different tasks. An eligibility check can confirm that the patient has active insurance but it is not a substitute for a VOB. Verifying a patient's benefits is necessary to understand the full coverage available and to obtain any required authorizations. To learn more about checking eligibility in Avea, click here. 

In the Management Center

The Management Center updates every 15 minutes and can be utilized to gauge your organization's current workload. As a best practice, we recommend using the Management Center daily to identify and complete any outstanding VOBs. Users can expect to see the VOB tiles in the Management Center update within 15 minutes of the insurance information being saved within the system. Let's review how to access the VOB section using the Management Center.

Management Center Workflow

• 1. Navigate to the Management Center.
     
     
  2. Locate the VOB Tiles.
     
  3. Select the VOB grouping tile you'd like to work.
     
  4. After being redirected to the Work Center, locate the VOB column.
     
  5. Click on the VOB hyperlink to be redirected to the Benefits section of the patient's profile.
     
  6. Select Edit to record the benefit information for the patient.
     
  7. After entering benefit information, toggle on Benefits Successfully Verified to remove the patient from the VOB que in the Work Center.
     
  8. Finally, select Submit to complete the process.
     

VOB Tile Definitions

The Management Center will display different tiles to indicate where additional work is needed in the verification process. Selecting any of the tiles will redirect you to the Work Center to complete the verification of benefits. 

• The Overdue tile will display incomplete VOBs that have exceeded the Service Level Agreement (SLA.) The SLA can only be configured by a Managing Organization Admin. For additional instructions on configuring the SLA, click here.
   
• The 0-30 Minutes tile indicates newly entered prospective or admitted patients need to have their benefits verified within the next 30 minutes or less. You still have time to verify benefits before this is considered overdue.
  
• The 31-120 Minutes tile indicates newly entered prospective or admitted patients need to have their benefits verified within the next 30 minutes or less. You still have time to verify benefits before this is considered overdue..
  
• The 121+ Minutes tile indicates newly entered prospective or admitted patients need to have their benefits verified within the next 30 minutes or less. You still have time to verify benefits before this is considered overdue.
  
• The Inactive Coverage tile indicates an eligibility check was run and the response stated the patient's insurance was no longer active.
  
• The Coverage Needs Review tile indicates the eligibility response received was anything but Active Coverage and needs to be reviewed.
   

In the Patient Profile

In addition to the Management Center and the Work Center, you can access the VOB section by navigating to the patient's profile. Let's review how to access and complete the VOB directly from the patient's profile. 

Patient Profile Workflow

• 1. Navigate to the Patients section.
     
  2. Next, click the name of the patient.
      
  3. In the Treatment Episodes section, locate the Quick Links dropdown.
      
  4. In the dropdown, click Intake.
     
  5. Next, select Insurance.
  6. Click on the payer name hyperlink to open the insurance set.
     
  7. Once you are in the insurance set, select Benefits.
     
  8. To update the benefits, click Edit.
     
  9. After entering benefit information, toggle on Benefits Successfully Verified to remove the patient from the VOB que in the Work Center.
     
  10. After you have obtained the benefits information from the payer, click Submit to complete the process.
      

VOB Fields and Definitions

The need to complete a VOB starts when a prospective or admitted patient is entered and insurance benefits are added.  Once the VOB has been completed, the information input can be downloaded for review by clicking the Download as PDF button. Let's review each section of the Benefits tab and the information it can provide. 

• The Payer Information provides demographic information for the payer such as the payer Name, address, and payer type. This information can be found and changed within the Payer tab of the insurance set.
  
• The Policy Information section includes the policy number, renewal information, coverage, period, etc. Some of the information that feeds into this section can be found and changed within the Policy Holder tab of the insurance set.
  
• The Deductible/Policy Coverage section includes both individual and family deductible amounts, the max out-of-pocket benefit, information about 3rd party pricing, etc.
  
• The Authorization/Exclusions Information includes fields for exclusions, out-of-state benefits, as well as COB information.
   
• The Coverage Breakdown section can document both in-network and out-of-network coverages.
  
• The Policy Notes can be used to document any relevant information obtained during the verification process.