The Eligibility tab within our Medical Billing software allows you to check a patient's active coverage, as well as benefits information, before billing out a claim. 

How to run eligibility

From the eligibility tab

Click Eligibility in the top navigation bar. 

Click Request Eligibility. 

Enter the Patient Name, then select the Case, Payer, Eligible Payer, and Provider from the corresponding dropdown menus. Enter the Service Date, choose whether to Run Eligibility By Service Type or CPT Code, and choose the appropriate option from the dropdown menu. Next, click Run Eligibility.

In the grid below, you'll see the Date Requested, Patient Name, Payer, Requested By, and a View button. Click View to see the patient's active coverage and benefits information.

From the patient dashboard

Click the Eligibility icon in the Demographics section.

Select the Case, Rendering Provider, and Case Payer, then enter the Service Date and choose the Eligible Payer. Decide whether you'd like to run eligibility By Service Type or By CPT Code, and select the appropriate option from the dropdown menu. Then, click Check Eligibility.

In the Eligibility Log grid below, you'll see the Requested Date, Requested By, Case Name, and Payer. Click View to access the patient's active coverage and benefits information. To download the 270/271 log, click the Download icon in the corresponding column.

Automatic batch eligibility

Click Utilities on the top right side. 

Click on Preferences, then click on Company Preferences.

Select Yes to Turn On Batch Eligibility.

Click Save. 

Note: You will need to log out and back in to ensure the preferences are set.

You can access unbilled encounters by clicking on Encounters in the top navigation bar or selecting Unbilled Encounters from the Alerts section. 

The Eligibility column displays the status of the eligibility check.

• Un-initiated - This means, the record wasn't a part of any previous eligibility batch check. You can hover over the icon to see the tooltip. 
• Success - This means, the eligibility run is complete and the report is available for viewing. 
• System Error - This means, eligibility could not run because of a system error. You can hover over the icon to see the tooltip. 
• In Progress - This means, the eligibility check is in progress. 
• Error - On hover, you'll see a tooltip with comma-separated validations listed. 

Click View Batch Report to view the report links for every record with a successful eligibility check. The pop-up can be printed in PDF format.  

You can manually run an eligibility check from the ubbilled encounters tab by clicking the Run Eligibility button. 

You will get a pop-up confirmation asking "Are you sure you want to run eligibility? Eligibility will run for all encounters in the Unbilled - Review tab with a Service Date within the last 6 months." 

Click Confirm. 

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