This section helps verify a patient's insurance coverage, determine covered services, and identify any co-payments or deductibles the patient may owe.
Steps to Check Eligibility
- Navigate to Eligibility in the left navigation menu.
- Select a Provider from the dropdown.
- Choose a Payer from the second dropdown.
- In the Eligibility Informationdropdown, select:
- Benefit Type (selected from the dropdown), or
- Procedure Code (entered manually).
- Provide patient details—Policy# or Date of Birth is required.
- Click the button to generate results.
Eligibility Results
- Use the Jump to Benefit Category dropdown to navigate directly to specific categories like Pharmacy, Urgent Care, and Physical Therapy.
Searching Eligibility History
Use the Eligibility History search to find previous eligibility queries. From the Eligibility screen, click the Search button in the upper-right corner of the Eligibility screen.
The Search Elig History window will open. Enter any available search criteria to filter the eligibility history results.
You can filter by:
- Insured Name — Enter the name in LAST, FIRST format.
- Insured Number — Enter the insured or member number.
- Payer ID — Enter the payer ID.
- Query Date — Enter the date of the eligibility query.
- Filter By — Choose whether to search My History or All History.
My History searches only the eligibility history associated with your user account.
All History searches eligibility history for all users. Use this option when you need to find a query that may have been submitted by another user.
After entering the search criteria and selecting the appropriate history option, click Search to view the filtered results.
Prevent Unnecessary Eligibility Requests
Avoid increasing your organization's eligibility transaction count by repeatedly clicking the button for the same patient.
Instead, follow these steps:
- Click Search.
- Enter patient details in the pop-up window.
- Use the Filter By dropdown to select My History or All History.
- Select the patient’s record in the Eligibility - Live Payer Response Panel.
Populating Eligibility Fields from a Claim
Eligibility search fields can be pre-populated from the View/Edit Claims page to save time.
- In the Other Actions dropdown, select Check Eligibility.
- The system auto-fills the Provider, Payer, Eligibility Information, and Patient Information.
- Click to view results on the right-hand side.
Get Help
- To report an issue, click the
button in the View Eligibility pop-up. - Submit a ticket associated with the patient by clicking .
- Track the status of eligibility-related tickets in Support Tickets.