---
title: "Eligbility"
slug: "eligibility"
tags: ["Insurance", "Get Help", "coinsurance", "Patient insurance coverage", "Co-Payments or deductibles", "copay"]
updated: 2026-08-19T20:50:29Z
published: 2026-08-19T20:50:29Z
canonical: "docs.claim.md/eligibility"
---

> ## Documentation Index
> Fetch the complete documentation index at: https://docs.claim.md/llms.txt
> Use this file to discover all available pages before exploring further.

# Eligibility

This section helps verify a patient's insurance coverage, determine covered services, and identify any co-payments or deductibles the patient may owe.

![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1680534760888.png)

### Steps to Check Eligibility

- Navigate to **Eligibility** in the left navigation menu.

1. Select a **Provider** from the dropdown.
2. Choose a **Payer** from the second dropdown.
3. In the **Eligibility Information**dropdown, select:
  - Benefit Type (selected from the dropdown), or
  - Procedure Code (entered manually).
4. Provide patient details—Policy# or Date of Birth is required.
5. Click the  button to generate results.

ImportantMost 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.  
![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1683744497141.png)

Web Portal Request LimitsThe portal has limits on eligibility checks per second. Exceeding the limit results in: **"Error: Too many requests. Try again later."**

### 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.

![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1783434000513.png)

The **Search Elig History** window will open. Enter any available search criteria to filter the eligibility history results. ![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1783434954754.png)

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

Warning!

Avoid increasing your organization's eligibility transaction count by repeatedly clicking the button for the same patient.

Instead, follow these steps:

1. Click **Search**.
2. Enter patient details in the pop-up window.
3. Use the **Filter By** dropdown to select **My History** or **All History**.
4. 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](/v1/docs/viewediting-archive) page to save time.

1. In the Other Actions dropdown, select **Check Eligibility**.
2. The system auto-fills the Provider, Payer, Eligibility Information, and Patient Information.
3. Click  to view results on the right-hand side.

### To print eligibility results

1. In the top-right corner of the Eligibility screen, click the **Printer** icon.  
![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1787172506552.png)
2. Follow the print prompts to select your printer or save the results as a PDF.

### Get Help

- ### 

To report an issue, click the ![](https://cdn.document360.io/367e6528-88da-4443-9da1-fcdd7e6d4d49/Images/Documentation/image-1693933340729.png) 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**.

**Note:** If the issue is related to **Invalid/Missing Subscriber/Insured ID**, [attach the patient’s member ID card](/v1/docs/how-do-i-add-a-document-to-an-existing-support-ticket) information when opening the ticket.