Key Features that an Insurance Reimbursement Software Must Have

Insurance reimbursement is an integral part of a medical practice or business. It is an effective way to ensure that treatment expenses are covered and offers long-term benefits. It not only helps patients in financial distress but also helps them maintain their health with regular medical checkups.

On the other hand, managing insurance reimbursement can be time-consuming and tedious for doctors and their staff members. With so much work involved in this process, it becomes essential for you to have effective software that can help manage insurance reimbursements efficiently while still keeping up with all your other responsibilities.

Integration With EHR, Practice Management systems

When it comes to insurance reimbursement software, integration with Electronic Health Records (EHR) is a must. In today’s medical practice, most of the patient information is handled by an EHR system.

This information can be imported into your insurance reimbursement software and used for many purposes, such as creating claims and managing accounts payable. This integration allows you to create an accurate claim using this information without manually entering it into the system.

In addition, the claims are automatically created using the patient and insurance information from the EHR when submitted through your online portal or API (application programming interface). The claims are then automatically routed to the appropriate insurance company for processing based on their coding rules or payer IDs set up in your system.

Eligibility Verification and Patient Matching

Ensure that your software can check eligibility for reimbursement. This can be done for any type of patient, procedure, treatment, or test. It also verifies eligibility for the insurance company and plans being used.

Matching patients to their insurance plans based on their information, such as address and phone number, will help you ensure that you have the correct information about each patient in your database to verify their eligibility correctly.

Matching patients efficiently is vital for reducing medication dispensing errors. Data shows that around 7,000 to 9,000 Americans die annually due to errors related to medication dispensing. Moreover, these medication errors also cost $40 billion a year. Preventing these errors through efficient patient matching can help lower expenses.

Claim Submission and Tracking

The software must allow for the submission of claims in bulk and individually. It should also be able to track claim status and payment information, as well as claims management, through its dashboard to keep a close eye on your company’s finances.

You should have access to current information about past claims and see how much money has been reimbursed out of total pre-approved costs, along with other details like the history of all submitted invoices/expenses over time.

Denial Management

According to a report by the Kaiser Family Foundation, health insurers denied 18% of the claims submitted for in-network services in 2020. You need software that provides for easy handling of denials.

It should allow you to quickly find out the reasons behind the denial and also have a feature to appeal a denial if there is any. In addition, it should allow you to handle different types of denials and appeals separately.

Routine Follow-Up With Insurance Companies

Do you know what is more challenging than collecting insurance payments? Getting paid by your insurance company. Insurance companies are notoriously slow and often don’t respond, so you must stay on top of them and keep checking in.

Another issue is that some insurance companies send out the same denial letter for multiple claims from the same person. It’s a huge waste of time manually annotating each claim with a reason for denial, especially when those reasons are identical across many different claims.

Reports and Analytics

A Deloitte survey of health technology professionals found that 76% of respondents reported that insights and analytics were one of their top priorities. It is essential to have access to real-time analytics to ensure that your patients receive the most accurate and complete reimbursement. This will allow you to see how many claims have been processed and what percentage of those claims have been denied or approved.

It’s also essential that the software allows you to customize your reports based on parameters such as date range, patient type, and provider type. This will give you insight into how much each provider has made during a specific period and whether their reimbursements align with industry averages.

Online Billing and Payment Portal

Your practice management software should be able to integrate with the reimbursement software. This is so that you can seamlessly import patient data from your PMS and submit claims.

The insurance company integration allows you to send patient information directly from the billing application without manually entering the information in their system. A patient portal is also essential since it enables patients to access their medical records and make payments directly, reducing patient and provider costs.

If multiple insurance companies have contracts with your practice, there must be an option for auto-refunds or rebates of those claims where applicable. Otherwise, this could lead to losses on your side each time a claim gets denied by one of those companies based on technicalities such as incorrect coding or billing errors.

Features to Streamline Bill Collection

Recurring payments are necessary for any healthcare facility, as they allow the organization to ensure it has the funds needed for ongoing operations. The software should be able to track recurring payment due dates and ensure that these payments are made on time.

Additionally, it should have an interface that enables users to add notes on patient debtors’ accounts to streamline bill collection. This way, if you have a patient who is behind on their payments and wants them to pay off their debts by paying off smaller amounts over time, you can use this feature to set up an automatic payment plan. This feature will collect money from the patient through direct debit or credit card automatically each month until all of the debt is paid off.

This feature can also help save staff time by automating specific tasks, such as:

  • Sending reminders about insurance reimbursements after medical services have been provided
  • Requesting approval from higher management when necessary
  • Reviewing claims information before submitting them for reimbursement
  • Preparing statements of account after completing reimbursement procedures, etcetera.

This is important as various studies have found that administrative expenses in healthcare are very high. Automating these tasks can help reduce administrative errors and hence, overall expenses.


Choosing insurance reimbursement software can be a time-consuming process. But, if you have the correct information and know what to look for in insurance reimbursement software, finding one will become much easier.