Troubleshooting Eligibility Checks

Experiencing difficulties when running patient eligibility? Follow the troubleshooting steps below. 

1. Verify the Eligibility feature has been enabled.

   1. Go to the Account Administration section and select Services.

   2. Verify that Real-Time Eligibility is enabled.

2. Verify you have permissions to check eligibility. If you receive(d) a pop up advising you do not have permissions to check eligibility, partner with an Admin or Auth Rep on your account to edit your permissions.

3. Verify the payer participates in eligibility.

   1. Go to the Payer section and open the payer in question

   2. Within the Clearinghouse Connection right hand side panel, verify there is a checkmark next to Eligibility.

4. Verify who the provider checks eligibility under.

   1. Go to the Provider section and open the provider associated with the patient.

   2. Locate the Check Eligibility Under field, and identify the provider.  

5. Verify the provider(s) has a submitter number.

   1. Go to the Provider section and open the provider associated with the patient.

   2. Scroll down to the Internal Use table to verify if a Submitter number is populated in the designated field.

6. Verify the eligibility status is Active within the Provider section.

   1. Go to the Provider section and open the provider associated with the patient.

   2. Click Configure Eligibility and verify the payer is set to active.

7. Verify the payer does not require an agreement prior to being able to check eligibility.

   1. Go to the Payer section and open the associated payer.

   2. Within the Clearinghouse Connection right-hand side panel, verify if there is an Agreement Required link under Eligibility.

8. Verify the required agreement has been approved.

   1. Reference our Look-up Payer Agreements Help Article.