3. Insurance Verification

Verifying a patient’s insurance coverage is a critical step in the intake process. It ensures the client can access services, that your facility can be reimbursed, aligns expectations with their benefits, and helps your team coordinate care more effectively.

In the CRM, you can run three types of Verification of Benefits (VOB):

• Phone VOB: Manual call with insurance to verify details
• Instant VOB: Quick benefit summary from the clearinghouse
• Outside VOB: Sends info to a third-party billing service

Best Practice: Complete the Method of Payment field in each patient record. Options include:
Private Pay, Insurance, Self Pay, Grant, or Scholarship.

Best Practice: Complete the Method of Payment field in each patient record. Options include:
Private Pay, Insurance, Self Pay, Grant, or Scholarship.

Workflow 1: Phone VOB

Phone VOB process allows in-house staff to contact the insurance provider directly and complete the VOB form during the call. 

Team Structure

The best practice for managing Phone VOBs depends on the size of the team responsible for verifying benefits over the phone.

• Small Teams (1–3 staff): Use a standalone VOB assessment form.
• Large Teams (3+ staff): Use the VOB 2.0 Queue for centralized task management and reporting.
  • To use the VOB 2.0 application, Super users must enable the VOB 2.0 configuration under CRM Configurations.

Super User Tips: Create a VOB team in the Manage Teams area to designate team managers and members. This setup allows billing staff to assign or be assigned VOBs in the queue.

How to Run a Phone VOB

1. Navigate to the Prospect Record and select the Actions menu in the Insurance List section.
2. Choose Phone VOB.
   
3. The request will be sent to the VOB Queue, where your billing team can work on existing VOB requests. 
   
4. The billing staff should fill out and complete the VOB form while on a call with an insurance representative from the respective insurance company.
5. Once the staff member finishes working on the VOB request, they will change the status to Closed Complete and select Update. This removes it from the active VOB queue.
6. The form will be stored under the Phone VOB History tab of the patient record. The VOB form can be PDF'd and transferred to the EMR. 

• Super Users can enable email alerts to streamline this process:

  • Notify when VOB Phone is Requested
  • Notify when VOB is Assigned
  • Notify when VOB Needs Approval
  • VOB Closed or Delayed (All Users)
  • VOB Closed or Delayed (Only Requestor)

Assigning and Reviewing VOB Forms

For teams with designated managers:

1. A manager assigns the VOB to a team member via the VOB Queue.
2. The assigned team member is notified by email.
3. After completing the request, the team member changes the status to Needs Approval.
4. The manager reviews and, if approved, updates the status to Closed Complete.
5. The VOB request will be removed from the active VOB Queue and linked to the patient record under the Phone VOB History tab.

Workflow 2: Instant VOB

Use Instant VOB to retrieve basic benefit summaries from the clearinghouse—ideal for after-hours, weekends, or holidays.

Required Fields

Before submitting an Instant VOB, ensure the following are completed in the patient record:

• Patient Name
• Date of Birth
• Member ID
• Insurance Provider (Tenant Payor)
• Subscriber Name
• Subscriber Date of Birth

How to Run an Instant VOB

1. In the patient’s Insurance List, open the Actions menu.
2. Select Instant VOB.
3. A general benefit summary will populate and save automatically to the Instant VOB History.
4. You may download this file and send it via email as needed. 
5. Instant VOBs must be exported as PDFs to be uploaded to the Kipu EMR.

Best Practice: Always follow up with a full Phone VOB to confirm accuracy and authorization.

Workflow 3: Outside VOB

Use Outside VOB to securely send benefit requests to a third-party billing vendors that include the prospect's insurance policy information. 

Super User Tip: Super Users must configure VOB Contacts under CRM > Facility Contacts.

How to Send an Outside VOB

1. In the Insurance List of the patient record, select Outside VOB.
2. Choose the appropriate external VOB contact and click Send Email.
3. Two emails will be sent:
   1. One with a password
   2. One with an encrypted PDF of the patient’s insurance information
4. The recipient uses both emails to access the file securely.
5. Billing staff should share the completed VOB with the admissions team by phone or email.
6. Admissions staff can upload the file via the Manage Uploads icon, ensuring it syncs to the EMR with the patient record.

Workflow 4: Private Pay/Scholarship

Super User Tip: To support Private Pay or Scholarship clients, go to Admin > Payor Administration and create a custom payor record—this lets you assign it in the patient’s insurance section and ensures accurate billing and EMR sync.