Overview
Procentive's eligibility feature provides real-time reporting. It also provides you the ability to search and select clients that meet certain criteria. This article will explain the different steps for running eligibility for multiple clients with a single click.
Make Your Selections
- Click on the Eligibility Module.
- Using the filter section at the top of the screen, select a batch of clients.
- The clients that meet this criteria will appear in the table below.
- To improve load time for this module, we recommended choosing an Appointment Location or a Program.
- Check Minnesota MA Only if you'd like to run eligibility for free payers only.
- Some payer charge a fee.
- See the payer list here.
- You can control if staff are allowed to run eligibility on free payers only or all payers from an agency level: Agency Setting. If allow free payers only has already been chosen in your setting module, you do not need to choose it again here.
- Either option will include Minnesota's Prepaid Medical Assistance Programs (PMAP's), however, you must complete the set-up requirements.
- Some payer charge a fee.
Important: Fees may apply if you do not check Minnesota MA Only.
Send Requests
Multi Requests / All Clients
- To select all clients, click in the check box in column header labeled Check.
- A blue check button will appear.
- Click Check.
- A report link will appear in the Eligibility Check Status column (example: response 7/19/2016).
Important: If your selection has multiple pages, you will need need to do Step 1 on each page.
Multi Requests / By Payer
With this option, you can check eligibility for all clients with a given payer -- regardless of whether the payer happens to be the client's primary, secondary, tertiary or other.
- To select by Payer, click the By Payer radio button at the top of the Eligibility Module.
- Select the payer from the drop-down.
- To select all clients for the payer, click in the check box in column header labeled Check.
- A blue check button will appear.
- Click Check.
- A report link will appear in the Eligibility Check Status column (example: response m/dd/yyyy).
Individual Requests / Specific Clients
- To check for a specific client locate that client's row.
- To check the client's primary insurance, click the check box in the check column.
- To check the client's non-primary payer, click the check box to the right of that payer.
- To check the client's non-primary payer, click the check box to the right of that payer.
- A blue check button will appear next to the box you checked.
- Click Check.
- A report link will appear in the Eligibility Check Status column (example: response m/dd/yyyy).
Inactive Coverage Flag
If the response shows that a client's coverage is inactive, Procentive will display INACTIVE above the response report link.
Real-Time Reports
- To view your results, click on the report link response 7/19/2016 in the Eligibility Check Status column.
- The Eligibility Inquiry Results window will open.
- The Eligibility Inquiry Results window will open.
- Review the report to determine if client has active coverage.
- If the client has active coverage, place a check in the Reviewed column for this client.
- The checkbox will be replaced with the reviewers name and the date.
- The checkbox will be replaced with the reviewers name and the date.
- If coverage is inactive:
- Click on the number link in the Payers column, to the left of the payer name.
- This will take you to the Clients Module, Payers tab, Enrollment sub-tab.
- In the Active: field at the top, select Inactive.
- If you know the correct payer, you can add or reactivate it now.
- Click on the Eligibility Dates sub-tab
- Click on the calendar icon in the To: date column
- Select the correct end date.
- If there are any service lines that have been saved under the newly inactivated payer for a DOS outside of this date, this setting will prevent them from being billed under the wrong payer.
- Click Save.
- This window will close and you will once again be in the Eligibility Module.
- Place a check in the Reviewed column for this client.
- Click on the number link in the Payers column, to the left of the payer name.