Check Eligibility Window

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.

How to Get Here?

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

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: 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)*	Yes	The 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.
Rank	Display Only (pulled from created/updated Case* in Charge Batch)*	Yes	The rank of the insurance on the claim: 1 represents the primary insurance 2 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.
Links
TriZetto Payer Search	Link to external URL	N/A	Link to the TriZetto payer list. Use this list to identify payers that might require additional Eligibility enrollment.
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.

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.

Error Report

[Alt] + [C]

To generate the report of cases that cannot be submitted for Eligibility.

Click Error Report. The Save As window opens.
Select the save location.
(Optional) Update the File Name. Note: The File Name defaults to the date and time the report is generated.
Click Save.

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