PERMISSIONS REQUIREMENT: Organization Administration Permissions are required to enable eligibility checks.
Billing Permissions are required to run individual and batch eligibility checks.
NOTE: Feature availability depends on your subscription plan.
Insurance Eligibility Checks
Those using Apex as their clearinghouse have 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.
NOTE: Eligibility checks do not provide co-insurance. deductible or copay information.
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Before you begin:
Before enabling eligibility checks be sure that you have the following required fields completed in your Organization Settings:
- Payer Id and Insurer Name
- Client details: First Name, Last Name, DOB, Sex
- Group Number and Insured Id Number
- Organization NPI
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.
- Access the Organization tab.
- Click Claims Service on the left menu.
- Click the Eligibility Checks tab.
- Toggle Enable insurance eligibility checks to On.
NOTE: If you enrolled in Ensora Clearinghouse claims service before September 19, 2022 this pop-up will be displayed:
When you sign up for Eligibility and you had previously had Ensora Clearinghouse EDI payer enrollments completed prior to Sept 19, 2022, the system will automatically send an enrollment request to Ensora Clearinghouse EDI clearinghouse for you.
Once Ensora Clearinghouse receives that request, they will forward it to the Change Healthcare Enrollment Services. You will receive an emailed survey from Change Healthcare. Complete the survey for each payer where you would like to submit Eligibility requests.
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.
In the Eligibility column you will see one of the following;
-
- Eligible -
- Ineligible -
- Unavailable -