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Electronic Eligibility

CPS, C-EMR, PM

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Anonymous

(@Anonymous)

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New Member Guest

Topic starter

Does anyone have experince using electronical eligibility? We have had very sporadic issues with the request not going out and we have to re-run. In our current workflow we have about 25-30 users running eligibility through out the day. We were told by our VAR that this is a connection issue either at the Clearinghouse, Carrier or internal. From the testing we have done it almost seems as if it is only allowing 1 persons request to be submitted. From the sporadic nature of the issue does not seem like it is the Carrier website connection issue.

Anyone is using this tool successfully? Any insight into our issue would be appreciated.

Thank you,

Posted : December 13, 2012 8:15 am

Anonymous

(@Anonymous)

Posts: 0

New Member Guest

We use this tool successfully with many people using it at the same time. Our issue with it is the information that comes back and populates the notes box in the additional information pop up window. It is alot of information to weed through to see if, for example, prior authorization is needed on a particular service.

Does anyone know if this can be edited down??

How do other offices weed through this to alert scheduling staff regarding what is covered and what needs prior auth??

Thanks!!

Posted : December 18, 2012 2:57 am

angelahunsberger

(@angelahunsberger)

Posts: 290

Reputable Member

lmoir said:

We use this tool successfully with many people using it at the same time. Our issue with it is the information that comes back and populates the notes box in the additional information pop up window. It is alot of information to weed through to see if, for example, prior authorization is needed on a particular service.

Does anyone know if this can be edited down??

How do other offices weed through this to alert scheduling staff regarding what is covered and what needs prior auth??

Thanks!!

You can edit down the large responses that are returned. The actual eligibility responses you receive will vary by carrier. This is done in Admin - Edit - Insurance Carrier - EDI settings - Here is a screenshot.

Posted : December 18, 2012 3:56 am

Anonymous

(@Anonymous)

Posts: 0

New Member Guest

Thanks for the info!! It will be helpful.

Another questions...is there a report that can be run listing the patients that have not had their insurance verified, maybe by date of service? Because of issues with the insurance companies (website down, connectivity, or it simply isn't done by staff, etc.), eligibility status is either pended or not verified. It would be nice to be able to go back to these patients and either re-try or go out to the insurance company's website to verify, but we are having a hard time capturing them.

Any thoughts or ideas???

Posted : December 19, 2012 12:19 am

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