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We are experiencing an issue while performing the eligibility check: if any portion of a payer is inactive (dental, vision, etc.), the verification will come back inactive. This occurs even though a patient has medical coverage. When this happens, our registration staff has to take extra steps to ensure their coverage is active in the system.
Posted : September 30, 2014 1:28 am
As you discovered, if any service type contains an inactive coverage response then the overall coverage is marked as inactive. The following information is from a recent support WebEx with GE.
You can use service types to select which services should be considered. You can filter service types when the request is created or when the response is processed. The recommended way is to filter service types in the response.
Insurance Carrier
EDI tab
Modify Response Processor
Settings for Eligibility Processor
Process selected service type codes
You need to select at least one Service Type that returns Active Coverage (usually Service Type 30, but may vary by carrier).
Some carriers return Active Coverage for multiple Service Types.
Posted : October 1, 2014 2:33 pm
