PERMISSIONS REQUIRED: Organization Administration Permissions are required to enable eligibility checks. Billing Permissions are required to run individual and batch eligibility checks.
Insurance Eligibility Checks
To check a patient's eligibility, you will need to ensure that you have completed the following:
- Select the client(s)
- Ensure the user has Billing Permissions
- Ensure the user has Administrative Permissions
Please see below the criteria needed within the Client Details to check eligibility:
- Client First Name
- Client Legal Gender
- Client Date of Birth
- Client SSN
- Client Insurance Insured ID Number
- Client Insurance Group Number
The Organization NPI needs to be listed on the Organization Profile page, as well as the Payer ID listed within the Insurer's Details in the Billing Tab.
When the eligibility check is run and a green check icon appears, this means the check had no errors. If you receive an orange alert icon, this means the check could be submitted due to errors. You will need to correct the errors and then run the eligibility again.
Our integration with Ensora Clearinghouse provides the ability to run insurance eligibility checks to:
- Confirm eligibility instantly while onboarding a new client.
- Run checks individually in the client's profile.
- Batch check everyone with an upcoming appointment to know if their current insurance is still valid or if it needs to be updated.
- Check primary and secondary payers.
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Enable Insurance Eligibility Checks
Insurance Eligibility Checks must first be enabled.
NOTE: You must have an active subscription to Ensora Clearinghouse to enable Eligibility Checks. Learn More: Ensora Clearinghouse Enrollment
- Access the Organization tab.
- Click Claims Service on the left menu.
- Click the Eligibility Checks tab.
- Toggle Enable insurance eligibility checks to On.
NOTE: Click turned off when customers fail to pay their eligibility invoices to prohibit use of the eligibility checker.
Individual Insurance Eligibility Checks
Eligibility checks can be run on individual clients by staff with Billing permissions.
- Access the Clients tab.
- Find the desired client and click Client Name to display Client Details.
- Click Bill to & Insurance on the left navigation.
- Scroll down to the Manage Insurance section.
- Click Actions and select Run Eligibility Check. Client insurance eligibility result is displayed.
Batch Insurance Eligibility Checks
Batch Insurance Eligibility Checks may be made to verify client insurance eligibility prior to upcoming appointments.
- Access the Billing tab.
- Select Batch Eligibility. The Batch Eligibility Checks page is displayed.
- Select the the desired date range for Upcoming Appointments.
- A table is displayed showing:
- Client - search for an Individual Client using the box at the top of the column.
- Next Appointment Date - next scheduled appointment in the calendar.
- Insurance - name of the insurance company.
- Type - indicates primary, secondary or tertiary insurance for the client. If the client has three providers, the client will appear in the table 3 times. Select each entry to check eligibility for all providers for a client.
- Last Checked - date last insurance eligibility check was run.
- Eligibility - status as of Last Checked date.
- Select all or multiple clients.
- Click Run Checks on Selected Clients.