Manage Real-Time Eligibility

Eliminate the time your staff spends on verifying patient eligibility with our Real-Time and Batch Patient Eligibility feature. With this feature, you can determine if a patient is eligible for insurance benefits in seconds, avoiding possible loss of payment. Eligibility is the first step to a clean claim.

If you're the Auth Rep, follow the steps below to enable, configure, or disable Real-Time Eligibility:

1. Select Account Administration > Services.

2. Click the button next to Real-Time Eligibility.

3. The Enable eligibility checking checkbox allows you to enable or disable this service.

4. Set your Eligibility Settings:

   1. Automatically check eligibility when saving appointment?

      1. Select Yes to have the system automatically verify a patient's eligibility when an appointment is saved.

   2. Automatically check eligibility when an appt has been set to Status: Use the drop-down menu to determine the (appointment) status that triggers the automatic eligibility check. 

   3. Automatically check eligibility when an appointment or claim is created over an Interface?

      1. Select Yes if you want an automatic eligibility check when creating an appointment or claim, from an SIU or DFT message received via the interface.

   4. Automatically check eligibility when a patient is created or updated over an Interface?

      1. Select Yes if you want an automatic eligibility check when creating a patient from an ADT message received via the interface.

   5. Limit automatic eligibility checking to: Use the drop-down menu to select the frequency in which you would like automated eligibility to run (once a visit, once a month, once every 30 days, once every 90 days, once per year, once per patient). 

      

      Please note that the "Once per Year" option is based on the calendar year. This means a patient with an appointment or claim on December 31st and another on January 1st will trigger an eligibility check for both dates, since they fall in different calendar years.

   6. Show user an alert if they lack permissions to check eligibility when saving an appointment that otherwise would have run eligibility automatically?

      1. Select Yes to alert the user when they don't have the necessary permissions to check Patient Eligibility.

5. Optional: Select Copy Configuration to copy these settings to another customer account.

   1. Check the box next to the customer account(s) to copy the settings to, then click Copy.

6. Click Save.