Eligibility Data contains response details that integrate with your existing eligibility data reports. Because payers provide information in varying formats and the range of benefit details is extensive, this data can be customized (via a custom report) to meet your specific needs. All of the fields within this category correspond directly to fields that can be found in the Eligibility Response screen.
Please see the steps below to add Eligibility Benefit Data to your existing Eligibility Requests report.
| Name | Description |
| Benefit Type | Displays benefit category (e.g., copay, deductible, out-of-pocket max), covering roughly 35 standard benefit types returned by payers. |
| Benefit Value | Allows you to drill into a specific service type within that benefit (e.g., Health Benefit Plan Coverage), with roughly 150 possible values to choose from. You must select your benefit value from the list when adding as a column or filter. |
| Benefit Index | Displays the benefit index for premiums and out-of-pocket medical costs. |
| Transaction ID | The unique identifier for the eligibility transaction. |
You can build a custom Eligibility Report using the Eligibility Requests Report as a template.
How to Build a custom Eligibility Report with Eligibility Benefit Data
Follow these steps to build a custom report that meets your specific needs:
- Open up an eligibility result and select the Eligibility/Benefit Details tab.
- Find out where the info is in the Eligibility Report.
- Go to Reports > Builder and select New Report.
- Build From Template using Eligibility Requests report
- Under the Eligibility Benefit Data, add Benefit Type to your report filters
- Set it as Static or use Default Values to match the value(s) from the Eligibility Benefit dropdown
- Set it as Static or use Default Values to match the value(s) from the Eligibility Benefit dropdown
- Find the Benefit Values you want from the Eligibility Report
- Add Benefit Value as a column
- Select the column header that you are interested in
- Keep adding Benefit Value as columns, selecting the different values based on the data you need
- The builder will show the values you selected in parentheses
- Click Save
