Overview

The Check Eligibility window is accessible from the Charge Batch / Charge Batch Information page, allowing you to select the cases for which you would like to submit an Eligibility inquiry request.

The table displays all non-reversed cases by insurance (payer/plan) by billing provider(s) found in the charge batch.

Eligibility submission requirements:

  • Eligibility inquiries can be submitted for a case on hold.
  • Eligibility inquiries can be submitted for a submitted case.
  • Case Status cannot be "Reversed".
  • Case must have a Provider defined on it.
  • The practice on the case must be set up as "Eligibility Enabled" with the Clearinghouse.
  • User must have Eligibility "Create" permissions assigned to him/her.

Your practice must be enrolled for Eligibility services, set up through your Clearinghouse, and given permissions in Back Office Admin in order to utilize this functionality.

How to Get Here?

From the Home Page:From the Menus:Via Shortcut Keys:
  1. Click Charge Batches from the Manage list.
  2. Double-click the charge batch to review.
  3. Click Check Eligibility.
  1. Open the Manage menu and select Charge Batches.
  2. Double-click the charge batch to review.
  3. Click Check Eligibility.
  1. Press [Alt] + [M] + [C].
  2. Double-click the charge batch to review.
  3. Press [Alt] + [E].

 



Field Definitions

Field

Type

Required

Description

Filters SectionFiltersNo

Allows the list of cases to be filtered by Case Status, Patient, Provider and/or Rank.

As you type in the Patient and Provider fields, the cases in the list are filtered to show only those that match what was typed. To restore the list to all cases, clear the contents of the filters.

Cases Table


SelectCheckboxNo 

Indicates whether the case is selected for submission of an Eligibility inquiry.

The field is disabled for lines with errors. These lines are displayed in red font.

Case ID

Display Only

(pulled from created/updated Case in Charge Batch)

YesThe identification number of the case.
Case Status

Display Only

(pulled from created/updated Case in Charge Batch)

Yes

The status of the case. Options include:

  • Unsubmitted
  • Submitted
  • On Hold

This is the Case's status, not the Eligibility Inquiry status.

DOS

Display Only

(pulled from created/updated Case in Charge Batch)

YesThe date the service is rendered.
Payer/Plan

Display Only

(pulled from created/updated Case in Charge Batch)

Yes

The insurance payer/plan on the case with financial responsibility for the outstanding debt. 

Eligibility Checks for an account having more than one insurance tied to it will only perform and return details for the selected insurance(s) on the case.

Rank

Display Only

(pulled from created/updated Case in Charge Batch)

Yes

The rank of the insurance on the claim:

  • represents the primary insurance
  • represents the secondary insurance
  • 3 or greater represents a tertiary insurance
Patient

Display Only

(pulled from created/updated Case in Charge Batch)

Yes

The name of the patient.

Provider/Practice NPI

Display Only

(pulled from created/updated Case in Charge Batch)

Yes

If there is a case in the Charge Batch without procedure data, this field will update with information necessary for the Eligibility Check, as needed. 

  • Defaults to the Provider Name is the information is present.
  • Defaults to the Practice NPI if the Provider Name information is not present.


Double-click the case record (or select a case and click the Update button) to open a selection box and change the default value displayed in the field. Options include NPI values of: 

  • Provider
  • Physician Group
  • PA Group
  • CRNA Group
  • AA Group
Links


TriZetto Payer SearchLink to external URLN/ALink to the TriZetto payer list. Use this list to identify payers that might require additional Eligibility enrollment.
STEMLink to external URLN/ALink to the Strategic Enrollment Manager (STEM) site to enroll payers that require Eligibility enrollment.

Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Update

[Alt] + [U]

To update the Provider/Practice NPI field's default selection.
  1. Select the case record to be updated.
  2. Click Update. The Select Provider/Practice NPI window opens. 
  3. Select the desired value.
  4. Click OK. The window closes and the field value on the case's eligibility request line item is updated.
Select All/Select None

[Alt] + [E]/

[Alt] + [N]

To select or de-select all records in the Check Eligibility table.
  • Clicking Select All checks all boxes in the Select column of the table.
  • Clicking Select None unchecks any checked boxes in the table.

The total number of records selected will appear next to the button.

Submit[Alt] + [B]To submit an Eligibility Inquiry
  1. Select the case(s) for submission of an Eligibility request. 
  2. Click Submit. The Check Eligibility window closes. 

The results are returned almost immediately and can be found on the Charge Batches / Eligibility tab.

For MediCal Eligibility Requests, the Provider's UPIN is required information. If the UPIN information is not documented on the Provider's record in Connect, the MediCal case row will not be selectable or eligible for an Eligibility Request submission. The UPIN information must be added to the Provider record before the Eligibility Request for the MediCal case can be submitted from this page.



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