Overview of Eligibility Verification

You need to verify insurance coverage before admission and ongoing to identify clients who no longer have insurance coverage. With Eligibility Verification, you can obtain real-time eligibility status without manual intervention. Real-time verification is automatic if:

  • The client is not admitted and you add or edit insurance in Intake Insurance Coverage.

    • You must include at least the following information for Eligibility Verification: 

      • Branch NPI

      • Eligibility Payer ID

      • Patient Last Name

      • Patient First name

      • Patient Date of birth

      • Social Security Number (SSN)

      • Member ID

  • You add or edit a Payer in a Client Financial Record. The Payer must have an Eligibility Payer ID setup.

Responses are stored in Intake Insurance Coverage or the Client Financial Record where you can view coverage details and re-verify eligibility on-demand.

Weekly, a batch process automatically re-verifies insurance eligibility for all active Intakes and Clients. You can easily manage failed responses using the Outstanding Eligibility Verification Transactions Dashboard or the Eligibility Verification Transactions Report.

Eligibility Verification accepts either the patient Health Insurance Claim Number (HICN) or the Medicare Beneficiary Identifier (MBI). If the HICN number is provided, the new MBI number is returned in the verification pdf for information purposes.