Online Eligibility Batch Verification Requests
Online Eligibility Window
Path: Transactions>General>Online Eligibility
With the Online Eligibility window, you can select patients to include in a batch file to be sent to eligibility vendor for insurance eligibility verification. The window consists of two tabs:
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Online Eligibility Window – Submit Eligibility Requests Tab – Use this tab to define patients for which you want to check eligibility. You can use the Patient Mode to filter patients by patient data or you can use the Visit Mode to filter patients by visit criteria. The Matching Results section displays the number of patients, insurance codes, and services (Visit Mode only) which meet your selection criteria and the total number of eligibility requests that will be sent. |
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Online Eligibility Window – Pending Eligibility Requests Tab – Use this tab to view any eligibility requests that are either pending or rejected by eligibility vendor. |
Note: Submitting online eligibility from this window requires a service be verified in either Scheduling, Transactions>General>Time Log, or Contract Invoices.
Online Eligibility Window – Submit Eligibility Requests Tab
Path: Transactions>General>Online Eligibility
On the Submit Eligibility Requests tab of the Online Eligibility window, you can set up parameters for submitting a batch of patients for eligibility verification. You can filter patients by selection criteria, view the matching patients, include or exclude any of the matching patients from the batch, create and submit an XML file to eligibility vendor for eligibility verification. You can view this tab either in Patient Mode or in Visit Mode by selecting the corresponding radio button in the top of the tab.
Using the Patient Mode, you can submit requests for patients regardless of whether they have visits scheduled for the verification date or not. Enter the verification date and the system will select patients that are active as of that date. You can select one or more class codes, insurance codes, or status codes to filter patients.
For example, you want to verify eligibility for all Medicaid patients with the Admitted patient status code. To do that, you need to select all Medicaid insurance codes from the Specific Insurances dialog and Admitted status codes from the Patient Status Codes dialogs. The dialogs appear while selecting the corresponding check boxes on the tab. When you click the Find Matching Patients button, the system finds all patients who have Medicaidinsurance and Admitted patient status code regardless of whether the patients have visits scheduled or not.
You can also define patient selection options. The batch request can be submitted for all or individually selected patients and you can set the request mode to filter patients based on the last verification date.
In the Visit Mode, you can only submit requests for patients who have visits scheduled. Enter the service begin date (required) and service end date (optional). The system will select patients who have visits scheduled within the defined date range.
You can select one or more service codes, insurance codes, or status codes to filter patients.
You can also define patient selection options. The batch request can be submitted for all or individually selected patients. Patients can also be filtered based on the last verification date.
You can set to submit requests for the first, last, first and last, or for all visits within the date range.
Submit Eligibility Request Tab – Fields
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Patient Class Codes (Patient Mode only)/Service Codes (Visit Mode only) |
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Submit Requests for Visits within Date Range (Visit Mode only) |
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Online Eligibility Window – Pending Eligibility Requests Tab
Path: Transactions>General>Online Eligibility
Using the Pending Eligibility Requests tab of the Online Eligibility window, you can view the status of eligibility requests to determine if they are still pending or rejected. This window displays patient code, patient name, service type code, submit date, batch number, and status.
Submit Eligibility Verification Requests in Batch Mode
Note: To perform this task, patients' insurance codes or companies should be set up for eligibility verification in the configuration Online Eligibility window (Administration>Configuration>Organizations>Online Eligibility).
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The Online Eligibility window appears with the Submit Eligibility Requests tab active.
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Define the submission parameters as appropriate to select patients and services to be included in the batch request. |
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Click Find Matching Patients to initiate the search for patients that match the selected submission parameters. |
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Click the Show Matching Result button to view patients that match the submission criteria. |
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In the Use column, clear the check boxes next to those patients to be excluded from the batch request. |
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Click the Submit Requests button to create and send the XML file containing the eligibility verification request data to eligibility vendor. |
Review Pending Eligibility Requests
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The Online Eligibility window appears with the Submit Eligibility Requests tab active.
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A grid appears containing data on pending and rejected eligibility verification requests.
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Processing Verification Responses and Downloading into Netsmart Homecare
Available eligibility verification responses are automatically retrieved and displayed on the Eligibility tab of the Payers window (Patient>General>Payers). There is no manual intervention required from the user.
Note: The Online Eligibility Web Service (included on your installation CD) must be set up to automatically retrieve available responses. Contact your system administrator or Client Support Services for assistance.