Automatic eligibility

An eligibility check is automatically conducted overnight for all patients with scheduled appointments for the following day.

If you do not use RXNT’s Billing and would still like to check eligibility through the system, this feature must be purchased as an add-on. 

To check eligibility results that were automatically processed overnight for today’s appointments, navigate to the Appointments tab, select Day View, and click the Eligibility icon.  

The Appointment Eligibility screen includes three tabs that help you identify the status of eligibility checks for scheduled appointments: 

• All - Displays all patients scheduled for the selected day, regardless of whether eligibility was successfully created or not. 
• Eligibility Created - Displays patients whose eligibility checks were successfully processed overnight. Users can review eligibility details for these patients by clicking the green icon next to the patient’s name. 
• Eligibility Not Created - Displays patients whose eligibility checks could not be processed. Eligibility may not be created for several reasons, including: 
  • Incorrect insurance information, such as an invalid payer ID or policyholder information
  • A self-pay case linked to the appointment
  • The payer does not support eligibility verification because it does not have an eligibility identification number

To access a patient’s eligibility information, click the green icon located to the right of the patient’s name within the Eligibility Created tab. 

Manual eligibility

A patient’s eligibility can also be checked manually from the Patient Dashboard. After opening the dashboard for the desired patient, click Eligibility to view or process the patient’s eligibility information. 

Select the patient’s case from the Cases dropdown menu, then select the appropriate payer from the Case Payers dropdown menu. 

Select the provider associated with the appointment from the Person Resource dropdown menu, then enter the appropriate date of service in the Service Date field. 

Eligibility can be verified by either Service Type or CPT Codes. 

To check eligibility by service type, select the By Service Type checkbox, then choose the appropriate service type from the Service Type dropdown menu. This option allows the system to verify coverage based on the category of service being provided. 

To check eligibility by CPT code, select the By CPT Code checkbox, then use the search field to locate and select the appropriate CPT code. 

On the Search CPT Code pop-up screen, enter the CPT code in the Code field, or type a brief description in the Description field, then click Search to view the results.  

The matching code and description will appear in the search results. Select the appropriate code from the list, then click OK to confirm your selection. 

After selecting either the service type or CPT code, click Check Eligibility to submit the request and retrieve eligibility results. 

Eligibility logs

Eligibility logs provide a comprehensive record of all eligibility checks performed for a patient, including both automatic and manual transactions. These logs allow you to easily track when eligibility was verified and review historical activity related to a patient’s coverage. By accessing the eligibility logs, you can quickly identify prior eligibility attempts and ensure that all dates of service have been properly processed. 

Click the icon in the View column to open and review the eligibility log. You also have the option to download the 270/271 transaction logs for reference or recordkeeping.  

• 270 (Eligibility Inquiry): This is the request sent to a payer to determine a patient’s insurance eligibility and benefits. It includes information such as patient demographics, insurance policy details, provider information, and the date of service.
• 271 (Eligibility Response): This is the response returned by the payer. It includes eligibility results such as coverage status, coverage dates, copay, deductible, and other benefit information, depending on what the payer supports.

View eligibility

The View Eligibility screen provides comprehensive health benefit coverage details for the selected patient. The left-hand panel displays a breakdown of the available information, organized by section for easy navigation.

To quickly view specific details, click on any section heading in the left panel. This will automatically take you to the corresponding section of the eligibility results. 

You can also print the eligibility information by selecting the Print option located in the upper-right corner of the screen.

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