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 Request Eligibility

Please refer to the Change Healthcare Eligibility Payer List for available payers.

From the Eligibility tab

Select Eligibility from the primary dark blue navigation menu, along the top. 

In the top righthand corner, select the Request Eligibility button. 

Screenshot 2023-09-18 093428.png

Enter the Patient Name, Case, Payer, Eligible Payer, Provider, Service Date, how you'd like to run Eligibility (by Service Type or CPT Code), and the Service Type/CPT Code. Then, select Run Eligibility in the corner. Screenshot 2023-09-18 093606.png

Once complete, the patient's Eligibility will be listed in the grid. Screenshot 2023-09-18 103331.png

From the Patient Dashboard

Access the Patient Dashboard you'd like to work on.

Select the Eligibility icon within the Demographics section.

Enter the Case, Rendering Provider, Case Payer, Service Date, Eligible Payer, determine if you'd like to run by Service Type/CPT Code, and select the Service Type/CPT Code. Then, click Check Eligibility on the right. Screenshot 2023-09-18 102129.png

Once complete, the patient's eligibility will be listed in the Eligibility Log.

How to View Eligibility

After running a patient's eligibility, you can view their active coverage and benefits information via the Eligibility tab within the dark blue menu bar at the top of your screen.

Select Eligibility from the navigation bar. 

All previously run eligibility information will be listed in the grid. Select the View button.Screenshot 2023-09-18 094734.png

From the Eligibility Log grid, select the view icon for the requested date.Screenshot 2023-09-18 102620.png

Automatic batch eligibility

RXNT now offers Batch Eligibility! When enabled, eligibility will be run for all patients with encounters in the Unbilled tab of the Encounters screen overnight, each night. 

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.

Navigate to the Encounters screen once eligibility has been enabled. 

There is now a Column included for eligibility.

In the eligibility column, the status of the eligibility run is indicated.

The status included the following:

  1. 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. 
  2. Success - This means, the eligibility run is complete and the report is available for viewing. 
  3. System Error - This means, eligibility could not run because of a system error. You can hover over the icon to see the tooltip. 
  4. In Progress - This means, the eligibility check is in progress. 
  5. 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 encounters tab by clicking the Run Batch 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." 

Click Confirm



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