Overview

The Eligibility page is comprised of three tabs:

The Eligibility / Excluded Payers tab is used to disable Eligibility checks for certain plans. When Eligibility is disabled, the plan will not display in the mapping tool and will not be included in error reports when Eligibility is run. 

How to Get Here?

From the Home Page:From the Menus:
  1. Click Eligibility from the Admin list.
  2. Click the Excluded Payers tab.
  1. Open the Admin menu and select Eligibility.
  2. Click the Excluded Payers tab.

 


Field Definitions

Field

Type

Required 

Description

Eligibility Excluded Payer List Section




FiltersFilterNo

Filtering options used to specify which payers are displayed in the Excluded Payers table.

Allows the list of collection information to be filtered by Payer ID and Payer Name.

As you type, the list is filtered to show only the data that matches what was typed. To restore the list to all excluded payer information, clear the contents of the filters.

Payer ID

Display Only

(pulled from created Eligibility Payer Exclusion record)

YesThe unique payer identification number associated with the selected payer.
Payer 

Display Only

(pulled from created Eligibility Payer Exclusion record)

YesThe name of the company that owns the plan to which claims are submitted and being excluded from Eligibility checks. 
Plan 

Display Only

(pulled from created Eligibility Payer Exclusion record)

No

The name of the plan to which claims are submitted and being excluded from Eligibility checks. 

Practice

Display Only

(pulled from created Eligibility Payer Exclusion record)

No

The name of practice where the payer is being excluded from Eligibility checks. 

Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Create[Alt] + [C]To add a new payer to the Excluded Payers (Eligibility check) list.
  1. Click Create. The Eligibility Payer Exclusion window opens.
  2. Open the Payer dropdown list and select the payer to be excluded.
  3. (Optional) Open the Plan dropdown list and select the specific plan associated with the payer above to be excluded.
  4. (Optional) Open the Practice dropdown list and select the specific practice associated with the payer above to be excluded.
  5. Click Save or Save & Add Next to add another payer exclusion. 

The selected Payer/Plan/Practice will be excluded from Eligibility checks.

A Payer must be selected for the exclusion. If no Plan and/or Practice is selected, all Plans and/or Practices associated with the Payer will be included in the exclusion.


Delete[Alt] + [D]To remove a payer from the Excluded Payers (Eligibility check) list.
  1. Select the excluded payer to be deleted from the table.
  2. Click Delete. The Delete Payer Mapping Exclusion confirmation window opens.
  3. Click Yes. The excluded payer is removed from the list and will now be included in Eligibility checks.





 

Related Topics

Eligibility

Eligibility / Configuration Tab

Eligibility / Payer Mappings Tab

Creating Payer Mappings



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