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Verifying Eligibility In Intakes

Use real-time Eligibility Verification to determine if a potential client has valid insurance coverage. You can verify eligibility if you add a new Intake or if you edit an existing intake insurance coverage. If you add a new Insurance or edit an existing one. Eligibility is automatically verified if the Payer has an Eligibility Payer ID associated. 

Note

After you admit a client, you cannot verify eligibility from Intake. You can verify eligibility from the client Financial Record > Payers and the process is similar.

  1. Intakes > Add or Edit Patient > Insurance Coverage

    • To add an Insurance, click Add Insurance

    • To edit an existing insurance, click Edit

  3. Click Accept. Eligibility Verification automatically processes.

To re-verify eligibility, from Intakes

  1. Click Edit next to the Patient name.

  2. Under Patient section, click Edit Patient. 

  3. Under Insurance Coverage, Eligibility Status, click View.

  4. Click Verify Eligibility.

  • Verify Eligibility is available depending on Eligibility Status. Use Eligibility Status to see the current status for a request or response.

  • From the date you submit an Eligibility request to Medicare, the response from CMS includes information spanning:

    • 12 months in the past and

    • Up to 4 months in the future.

  • Eligibility Verification accepts either the 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. 

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