Electronic Eligibility and Benefits
Eligibility requests retrieve benefit information from a Clearinghouse.
In the Insurance Plan window, in the middle, click Request.
Electronic eligibility and benefit information allows you to electronically verify a patient's insurance eligibility and benefits in real time (e.g. percentages, deductibles, maximums, limitations, and history). Non-subscriber benefits that are not identified as family coverage are inserted as patient override benefits.
Electronic Eligibility checks can be run as a batch by creating a Scheduled Process.
The following third-parties are known to offer eligibility services:
The Dates grid shows information on eligibility and active service dates.
Viewing Mode: Select how to view the response message. Options are Electronic Import or Message Text.
Mark for import if: Select whether benefits for In Network or Out of Network should be imported. Dependent on your disposition with the carrier.
Show Raw Message of...:
Print: If there are HTML responses, view and print the HTML. Otherwise, the main grid is printed.
This grid displays benefit details received from clearinghouse.
Import Benefit Coinsurance:
Current Group Num: The entered group number on the selected patient. A red warning will display if this does not match the group number reported by the carrier below.
Response Group Num: The group number returned by the carrier.
Import: Highlight benefit rows from the grid, then click to import benefits to the patient's plan. Prior to importing, users should review the highlighted benefit rows and Current Benefits grid (below) to ensure duplicate benefits are not imported.
This grid lists current benefits entered in on the selected patient's insurance plan.
Use the note box to record notes as desired when importing benefits.
Delete: Delete the response.
On the Edit Insurance Plan window, click History. All requests and responses are stored for future reference.