Pay Control – Eligibility tab

Path: Patient > General > Payers

Using this tab, the licensed Online Eligibility users can view an individual patient's insurance eligibility verification data.

• When a response to an eligibility verification request is retrieved and processed, the application finds the patient and matches up the verified insurance payer.
• The Eligibility tab is then completed with the data retrieved from the response file for each payer.
• You can review the most recent patient eligibility data in this window for each payer by selecting a payer in the Pay Source section of the window, and the most recent eligibility data will appear on this tab.

The Eligibility tab contains a grid with the patient's verification information: date of service, service type code, date when the patient's eligibility was verified by the payer, ID of the user who verified the patient's eligibility, and status of patient eligibility (active or inactive coverage).

You can enter any additional eligibility information for this patient, up to 250 alphanumeric characters, or view the actual verification report received for the patient.

• The fields are read-only except for the Reviewed and Notes columns.
• If needed, select the Reviewed check box to indicate that you reviewed the contents of the retrieved file response.
• When you select Reviewed, the current date and your user ID appear in the corresponding fields (Date Reviewed and Reviewed by) of this tab.

To refresh the Verification Data section of the tab with the latest eligibility data, click Refresh.

To review the patient's online eligibility history, click the Show History button.