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".
- 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.
Field Definitions
Field | Type | Required | Description |
---|---|---|---|
Filters Section | Filters | No | 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 | |||
Select | Checkbox | No | 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) | Yes | The 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:
This is the Case's status, not the Eligibility Inquiry status. |
DOS | Display Only (pulled from created/updated Case in Charge Batch) | Yes | The date the service is rendered. |
Payer/Plan | Display Only (pulled from created/updated Case in Charge Batch) | Yes | The primary insurance payer/plan on the case with financial responsibility for the outstanding debt. |
Rank | Display Only (pulled from created/updated Case in Charge Batch) | Yes | The rank of the claim generated for a case.
|
Patient | Display Only (pulled from created/updated Case in Charge Batch) | Yes | The name of the patient. |
Links | |||
TriZetto Payer Search | Link to external URL | N/A | Link to the TriZetto payer list. |
STEM | Link to external URL | N/A | Link to the Strategic Enrollment Manager (STEM) site to enroll payers that require Eligibility enrollment. |
Button Descriptions
Button | Shortcut Keys | Description | Step-By-Step Guides |
---|---|---|---|
Select All/Select None | [Alt] + [E]/ [Alt] + [N] | To select or de-select all records in the Check Eligibility table. |
The total number of records selected will appear next to the button. |
Error Report | [Alt] + [C] | To generate the report of cases that cannot be submitted for Eligibility. |
The report generated is a .csv file with the following info: Case ID, Case Status, DOS, Payer/Plan, Rank, Patient, Provider, Eligibility System Payer ID, Provider First/Last Name, NPI, Insurance Number, Insured First/Last Name, Insured DOB, Insured Gender, Dependent First/Last Name, Dependent DOB, Dependent Relationship, Dependent Gender, DOS Begin/End |
Submit | [Alt] + [B] | To submit an Eligibility Inquiry |
The results are returned almost immediately and can be found on the Charge Batches / Eligibility tab. |