Issuu on Google+

Eligibility Front Office

Powered by elligence! Synopsis: Save money by eliminating a leading cause of claims denials. Save staff time making calls to verify coverage. Use freed up staff time for patients and collection issues. Check eligibility in real-time or batch mode. Receive a response in less than a minute in real time mode. Automatic or Manual modes. How does it work? Insurance Plans on Emdeon’s real-time Payer List may be checked to determine if a patient is eligible for a particular coverage. For a list of payers available via Emdeon, please see: http://direct.medifax.com/webmd/payerlist.asp?db=era For available Payers, an automatic eligibility request is generated when: A new coverage is added. A "substantial" change is made to an existing coverage. An appointment is saved. The eligibility request will not be generated at that time; however, it will be at a specified time in the future. Every EDI destination has a “lead days” selection that allows the user to indicate how many days in the future the appointment should be when eligibility is checked. You may also manually generate an eligibility request by clicking the Check Eligibility button next to the patient's coverage: On the Patient> Coverage screen. On the Schedule> Appointment screen Eligibility information is shown on the patient coverage screen as well as available from a number of elligence reports. In addition, the scheduler will display a Y (eligible); N (Not eligible) or ? (Unknown) next to each patient’s appointment. Eligibility responses vary by Payer but may include information such as covered and non covered procedures, co-pays, deductible, effective coverage dates and more.

Data Strategies, Inc.


Eligibility Front Office

FAQs What costs are involved? An eligibility request and response for a Participating Payer is currently priced at $0.15 for the pair. For a Non-Participating Payer it is currently priced at $0.32 for the pair How do I get started? You must complete enroll paperwork that is available from Data Strategies, Inc. If you have already paid a one-time setup fee for Emdeon enrollment for any type of Emdeon transaction (claims, remittance, etc.), then no other fees are involved. If not, there is a one-time setup fee of $595.00. How many insurances coverages are available? Currently approximately 300 plans are available with more being added all the time. Remember, Emdeon is one of the largest clearinghouses in the country and they are actively seeking new plans. I use another clearinghouse for my claims and remittance. Can I continue to do so? Yes. elligence has been designed to accept different destinations for eligibility and claims. I don’t want to do online eligibility for all of my plans. Can I control which plans are enabled? Yes. You define which plans are checked and which are not via the Define> Insurance Plan screen. What kind of change to an insurance coverage triggers an eligibility check? An automatic eligibility check is triggered when one of the following has changed: Policy Number, Relationship code, Subscriber Name, or Membership ID. What eligibility-related reports are available? The Eligibility Verification Worksheet and Ineligible Coverages Reports allow you to view patients based upon their eligibility status, e.g. eligible, not-eligible, verified, awaiting response, etc. What kind of information will I get back? The information varies per Insurance Plan. Minimally you should receive a response that indicates whether the patient is eligible for the coverage you have on file in elligence. Many payers will provide much more extensive information including: Information Source: This tells you the payer who sent you this information. Information Receiver: This is the name of the person or non-person entity who made the request. Subscriber: This section lists all of the "standard" information that is typically printed on an insurance card including the subscriber's policy number, effective and termination dates of the coverage, etc. Eligibility or Benefits: This section lists the specific details of the subscriber’s coverage. Each line represents a specific benefit for which the patient is eligible, or a specific detail of their coverage.

Data Strategies, Inc.


MDsuite Eligibility Product Sheet