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.
Important
Most payers do not respond to the Procedure Code and only recognize the Benefit Type.
Eligibility Results
- Use the Jump to Benefit Category dropdown to navigate directly to specific categories like Pharmacy, Urgent Care, and Physical Therapy.
Web Portal Request Limits
The portal has limits on eligibility checks per second. Exceeding the limit results in: "Error: Too many requests. Try again later."
Prevent Unnecessary Eligibility Requests
Warning!
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.