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Viewing Eligibility Responses 

You can view responses, detailed error messages, and response failed messages resulting from Eligibility Verification requests.

Eligibility is automatically validated if you

  • Add new insurance.

  • Change a Client's or Intake's existing insurance information,

Responses are listed by date within one month from the current date. To view older responses, change the date range. The list includes responses for a maximum time-span of one year at a time.  Although you can print responses, you can always access historic responses if you do not delete the insurance record.

To quickly identify if further action is needed to verify eligibility, responses have colored banners at the top:

  • Red - Failed or Denied.

  • Green - Verified.

  • Orange - Response contains other Payer information such as:

    • Hospice.

    • Potential MSP (Medicare Secondary Payer). The type of MSP case appears in Plan Code.

    • Managed Medicaid. Plan Type is Managed Care Organization.

Managed Medicare and Managed Medicaid Payers and potential primary payer (MSP cases) appear in the Insurance/Commercial Other Payers section. The type of MSP case appears in Plan Code. 

To verify eligibility for another Payer, in the Intake, add insurance or in the Client, add the Payer.

Note

A weekly batch process automatically re-verifies insurance eligibility for all active Intakes and Clients. PointClickCare recommends you review Intakes and Clients eligibility reports weekly, after the batch process.

    • Branch: Intakes > Edit Patient > Insurance Coverage

    • Branch: Client > Financial Record > Payers

  2. Under Eligibility Status, click View.

  3. Under Actions:

    • To open the response, click View.

    • To save a copy on your computer, click Download.

  4. To re-verify eligibility, click Verify Eligibility.

Note

You can Verify eligibility for any status except Not Submitted.

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

    • 12 months in the past. 

    • Up to 4 months in the future.

  • Eligibility response reports contain a unique Transaction ID (txn_id) located at the bottom of the report on the right. Txn_id is used investigating the data in the report. If you need assistance with a report, log a Support case and include the txn_id. 

  • If there is an error or Eligibility Status is Failed, view details and resolution steps in the Eligibility History Error column.

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