Online Eligibility Workflow

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About Online Eligibility

The Netsmart Homecare Online Eligibility functionality is a licensed add-on feature that provides you with the means to obtain patient insurance eligibility information via online services in real time from within the Netsmart Homecare application. Real-time online eligibility saves you a significant amount of time by reducing manual work. With this feature, the time spent calling insurance companies to obtain eligibility information is reduced to dealing with exceptions. In addition, the number of insurance claim rejections can be reduced by verifying the patient's eligibility prior to the service being rendered, saving time on processing rejected claims.

With Online Eligibility, you can either submit a single request for a patient in real time, or generate a batch request for patients that will be submitted to Online Eligibility for eligibility verification. The response is then loaded into the patient's record for user review at any time.
A history of all responses is maintained in the application.

Online Eligibility Setup Workflow

1.	Install Online Eligibility.

2.	Contact Netsmart Healthcare Systems client support to license the Online Eligibility functionality.

3.	Contact your system administrator to assign appropriate privileges in the following components of the application:

>	Administration>Configuration>Organizations>Online Eligibility

Note: Access to this window is only needed for setup purposes. Access to this window is not required for use of Online Eligibility.

>	Patient>Online Eligibility

>	Transactions>General>Online Eligibility

>	Patient>General>Payers

>	Reports>Financial>Eligiblity Verification Status Report

4.	In the Online Eligibility window (Administration>Configuration>Organizations>Online Eligibility), define insurance codes and companies for which the online eligibility requests can be sent. Refer to Online Eligibility Window for more details.

Online Eligibility Workflow

1.	Access the Patient component and click in the toolbar of any of the windows with the patient selected to submit an eligibility verification request for this patient.

2.	Access the Online Eligibility window (Transactions>General>Online Eligibility) to submit a batch of patient eligibility verification requests and to view pending eligibility requests.

3.	Access the Eligibility tab of the Payers window (Patient>General>Payers) to view the responses to an individual patient's eligibility verification requests. Click Show History to view the patient's eligibility history and to manually enter eligibility information for the patient.

4.	Access the Eligibility Verification Status report (Reports>Financial>Eligibility Verification Status) to view the status of patients who are submitted for eligibility verification.