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Eligibility checking, insurance verification

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Last Post by ggregory 6 years ago

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jwyant

(@jwyant)

Posts: 1

New Member

Topic starter

We have encountered issues using GE Centricity’s eligibility verification. The data returned for each request is a large amount of data that is not parsed or summarized in anyway, making the viability of using the data impractical. We explored a third-party option, but that fell through as they required a ‘270’ batch file that GE Centricity is unable to produce. GE can only produce an individual file.

That being the case I am very interested to know what are you using for eligibility verifications, including a determination of co-pay/coinsurance/remaining deductible. Also, are you able to perform individual verifications and batch verifications?

As an FYI, we are using the GE Healthcare Centricity EDI for our clearinghouse.

Any information that you can provide would be greatly appreciated.

Posted : April 10, 2019 2:13 am

aroberts

(@aroberts)

Posts: 176

Reputable Member

We use Clearwave and have been very happy with it. We are able to do individual and batch.

Posted : April 10, 2019 2:44 am

SLHV

(@slhv)

Posts: 478

Honorable Member

My perspective is from the IT side. In the not-too-distant past, I was working with our staff regarding eligibility verification and related EDI issues. We also use Centricity EDI.

My understanding is that batch verification for scheduled patients occurs daily at a scheduled time. I believe early AM.

Our staff also runs on-demand verifications. The return is an X12 type 271 file (file structure details available somewhere at x12.org). The staff typically review these responses in registration. It is a basic text file that is decently formatted with fixed-width formatting. I don't understand all the various items items like multiple copays under what conditions and such, but I believe our staff does.

Mirth Connect (which Nextgen purchased and they keep trying to bury the free version deeper in their website) has an X12 interface channel. I've been tempted to set it up but have never had a reason to. It may provide some flexibility that you are looking for. If you're trying to parse the 271 data, Mirth could be used to extract the data and publish it via its API to a webpage for example. Just thinking off the cuff there.

-dp

Posted : April 10, 2019 2:58 am

tablok

(@tablok)

Posts: 19

Eminent Member

I know Summit offers a good eligibility parser: www.summitsoftech.com We aren't not using that product but use many of their other products and they are great! We just use the eligibility notes that come into CPS, which does offer problems particularly with verifying copay information. You can work with GE or your vendor to get certain service types placed towards the top of the eligibility response. For instance, we had the PCP information moved to the top of the response. That really helped. You also can remove service types from the response all together so the responses are not so long. I know I had our vendor do that for Medicare responses and now they are really short.

Posted : April 10, 2019 4:45 am

Michelle

(@michelle)

Posts: 38

Eminent Member

We are working with our VAR to set up EDI headlines which allows for specific information to appear in specific priority placement in the EDI response. This seems to be a good solution for us.

We are out of network so we also still call for each verification because the EDI responses do not provide all relevant data for an out of network practice.

Michelle

POA

Posted : April 10, 2019 7:16 am

SLHV

(@slhv)

Posts: 478

Honorable Member

Oh yeah. I should have mentioned that. If you work directly with GE/Virulence/AthenaHealth, try [email protected] for the EDI services folks. They are able to customize the eligibility data.

I'm not sure how that works with VARs.

-dp

Posted : April 10, 2019 7:34 am

ggregory

(@ggregory)

Posts: 1

New Member

I am newer to GE, although I have experience with other EHR's and it seems like when we run eligibility it takes a surmountable amount of time, either doing after we pre-reg each patient or run batches. I thought it was just our organization but when I began to ask around it seems as though we're not the only ones. Can someone please speak to this. Thanks in advance for your help and insight

Posted : April 20, 2019 11:10 am

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