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.
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 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:
|
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.
Click on the Provider/Practice NPI field to open a selection box and change the default value displayed in the field. Options include NPI values of:
|
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. |
The total number of records selected will appear next to the button. |
Submit | [Alt] + [B] | To submit an Eligibility Inquiry |
The results are returned almost immediately and can be found on the Charge Batches / Eligibility tab. |
Charge Batches / Case Holds Tab
Charge Batches / EDC Files Tab
Charge Batches / Eligibility Tab
Charge Batch / Charge Batch Information Tab
Charge Batch / Charge Batch Error Check Tab
Charge Batch / Concurrency Log Tab
Charge Batch / Image Batches Tab
Case / Patient, Guarantor & Insurance Tab
Case / General Case Information Tab
Case / Procedures & Provider Time Tab
Case / Additional Case Information Tab
Running Error Check Validation
Correcting Errors and Warnings