Automatic eligibility

An eligibility check is conducted overnight for all patients who have scheduled appointments for the following day.

In the Appointment tab, select Day View and click Eligibility. 

The Appointment Eligibility report displays the names of patients whose eligibility has been processed or not processed. If eligibility didn’t run for a patient, those patients can be found in the Eligibility not created tab. There are a few reasons why eligibility may not be processed. For instance, the insurance information, like the payer ID or policyholder, is incorrect, a self-pay case was linked to the appointment, or the payer does not have an eligibility identification number.  To access the eligibility information, click the green icon to the right of the patient’s name.

Manual eligibility

A patient's eligibility can also be checked from the Patient Dashboard. Once you’ve accessed the dashboard for the desired patient, click Eligibility.

Complete all mandatory fields, including Case, Case Payers, Person Resource, Service Date, and select to run by Service Type or CPT Code.

Click Check Eligibility.

Click the icon in the View column to view the eligibility log.

Viewing eligibility

The eligibility provides comprehensive health benefit coverage details. The section on the left provides a breakdown of the provided information. Click on a section heading to be directed to the corresponding section. 

This information can be printed by clicking the Print option on the top right side.

Eligibility logs

Eligibility logs retain records of both automatic and manual eligibility checks. You can access the logs by navigating to the eligibility icon located on the Patient Dashboard. This allows you to easily see all dates of service that had an eligibility check. To view the eligibility information, click the blue icon under the View column. 

Still need help? Contact us!

Have a great idea? Tell us about it!