Tracking down missing health coverage has always been challenging for providers, but proposed changes to the Affordable Care Act and Medicaid could make it even tougher. If the reforms take effect, as many as 13.7 million Americans could lose health insurance over the next decade. With more patients cycling in and out of coverage, many will turn up for care without knowing their coverage status, leaving them at risk for bills they can’t afford and exposing providers to denials and revenue loss. Insurance verification has traditionally relied on Social Security Numbers (SSN). As the industry moves away from this approach, providers need faster, more reliable ways to confirm health insurance without SSNs.
Health insurance without an SSN? The challenge of missing SSNs in patient records
For decades, the SSN was a go-to data point for verifying insurance coverage. In the absence of a national patient identifier, it served as a consistent way to match individuals to their insurance records across health systems and payers. However, many patients do not have SSNs, and concerns about data privacy, duplication and identity theft led providers and payers to phase out SSNs. Although SSNs may still be collected during enrollment for administrative use, industry best practice now discourages using SSNs unless absolutely necessary.
Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. For instance, in 2018, Medicare replaced SSN-based Health Insurance Claim Numbers with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person’s identity for Medicare transactions like billing, eligibility status and claim status. Commercial health plans have followed suit, relying more heavily on member IDs and internal identifiers for billing and eligibility and avoiding SSNs in patient records in line with privacy rules set out in the Health Insurance Portability and Accountability Act.
As a result, SSNs are disappearing from patient records and payer databases. The question for providers is how to accurately verify insurance without SSN access.
The impact of unidentified insurance on claims and reimbursement
When active insurance coverage is overlooked, providers lose the opportunity to bill for care. Some patients will be incorrectly assigned self-pay status, triggering unnecessary billing cycles or charity write-offs. Others get care without providing their coverage information at the time of care, especially in fast-moving outpatient and emergency departments. Either way, the revenue is at risk in situations like these.
Providers lose time and revenue. Teams are forced to reprocess claims, track down retroactive coverage, and appeal denials that could have been avoided.
Missed coverage also takes a toll on patients, who now owe more than $220 billion in medical debt. And with cost concerns prompting four in ten patients to consider skipping care when they don’t receive a price estimate, missing coverage is more than a paperwork problem – it’s a clear threat to health and well-being.
Strategies to identify health insurance without an SSN
As the use of the SSN in medical billing declines, providers are looking for new and better tools to find insurance coverage. Digital technology and data integration make it possible to verify insurance without SSN use. Here are a few of the most effective strategies:
1. Using probabilistic matching and third-party data
Advanced coverage discovery platforms now use probabilistic matching to connect patients to payers. These tools analyze data points like name, address, date of birth and phone number to identify likely matches. Instead of needing a patient’s exact identifiers, they calculate match confidence based on data quality and historical payer data.
2. Leveraging health information exchanges (HIEs)
Another option is to connect to regional or statewide HIEs to check insurance details shared across health systems, payers and public programs. This is especially valuable for transient or underserved populations who often move between providers and may not always carry updated insurance cards.
3. Patient self-service portals with identity validation
At the front end, patient self-service tools offer opportunities to collect insurance information before a visit. Identity validation technology helps confirm the person’s identity without requiring an SSN. Patients can scan an insurance card, update coverage details or answer verification questions within the portal. This reduces the workload for front desk staff and ensures better data before the patient arrives.
Automated tools to streamline insurance discovery
While patient access tools help patients confirm their coverage details, automated back-end solutions are essential for identifying insurance when information is incomplete or missing. Intelligent coverage discovery platforms can predict and verify active coverage without relying on SSNs, using demographic inputs like name, address and date of birth.
These platforms run real-time or batch searches across multiple proprietary databases, combining search best practices, historical claims data and payer response patterns to flag likely matches. At the point of scheduling or registration, automated eligibility checks help identify billable coverage early, reducing errors, manual work and missed reimbursement opportunities.
Experian Health’s Coverage Discovery® exemplifies this approach, uncovering commercial, Medicare and Medicaid coverage that may have been unknown or forgotten. By identifying primary, secondary and tertiary coverage, it flags accounts that might otherwise be written off or sent to charity. Not only does this help maximize reimbursement revenue, but it also automates the self-pay scrubbing process and reduces the number of accounts sent to bad-debt collections. In 2023 alone, the platform identified billable coverage in more than 30% of self-pay accounts, resulting in over $25 million in found coverage.
This level of automation is especially critical as policy changes continue to disrupt coverage stability. Proactive alerts can flag patients previously marked as self-pay but now linked to valid insurance, helping providers course-correct before claims go unpaid.
Better patient matching, better outcomes
As insurance coverage becomes more complex, providers need smarter and more efficient ways to verify it. Automated platforms like Coverage Discovery identify active insurance using minimal patient data, improving accuracy and reducing dependence on SSNs.
When active coverage isn’t found, Patient Financial Clearance helps fill the gap, screening for Medicaid eligibility or identifying patients who may qualify for charity care. Together, these tools give providers a more complete financial picture and ensure patients are connected to the coverage or support they need.
The result is not just cleaner claims and faster payments, but better patient and provider outcomes. With more than a fifth of patients experiencing delays in healthcare because of issues verifying insurance information, improving coverage accuracy is a win for everyone.
Find out more about how Coverage Discovery can help healthcare providers reduce bad debt by verifying patients’ health insurance coverage without SSNs.
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