PLEASE NOTE - The feature below is only available for Claim.MD or Trizetto customers only. If you'd like to hear more about Claim.MD please contact the Helpdesk and we'd be happy to go over the options.
The current check eligibility for a single patient feature can be found under the Tasks menu, Check Eligibility Single Patient or from within the patients insurance tab in the Co-pay section, Check Eligibility button.
The Check Eligibility screen for a single patient looks like this:
We have added another function that allows an office to check eligibility for a list of multiple patients at the same time.
The steps for the new Check Eligibility for Multiple Patients feature can be found below.
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1. There are two ways to access the batch eligibility feature. The item “Check Eligibility Multiple Patients” can be found under the Tasks menu.
It will allow you to build a list of patients and then check eligibility for the patients. Options for searching patients and generating the list are:
- Appointments on Dates
- Charge(s) posted in date range.
- First/Last Name
- Case Doctor
- Rendering Doctor
The Check Eligibility for Multiple Patients (aka batch eligibility) is also available from the Appointments Scheduler. To access this feature from the appointment calendar, right-click on the column header for a specific day and the last menu item is the batch eligibility check. The placement of this feature on this menu provides the ability to check eligibility for patients scheduled to be seen on that date. The patients are queued for the batch check. If you are not a customer of Trizetto this feature is unavailable to you.
2. The search items mentioned above are displayed in the Batch Eligibility screen below. Enter you search criteria here:
The Search Filters
We added a variety of filters to the batch eligibility function.
From these options, you can select to include patients with the following criteria:
- An appointment in specific range.
- Charges that were posted in a specific date range.
- Filter by first or last name.
- A specific case provider.
- A specific rendering provider.
The Service options at the bottom are needed to specify what kind of service you are checking for.
The billing profile drop down is helpful if there is a specific NPI or Name that the eligibility must use to retrieve information.
The list will automatically refresh when you make a change to a filter.
3. After selecting the filters, the grid at the bottom will be automatically updated with the search results.
Here is an example of the results:
4. The check mark at the side will allow you to select/deselect which patients you want to retrieve eligibility for from the result list. The column “Status” will be blank and the row color will be white if you have not retrieved eligibility for this patient as of yet.
When you retrieve eligibility information, the results will come back in these default colors specifying what has happened:
If the item is “No Coverage” or “Success”, eligibility was returned. If it is “Error”, something was wrong with the information sent to the check eligibility process.
Picture of data returned.
On the right side of the window, human readable form of the eligibility request can be viewed:
5. Marking the checkbox next to the Updated column, you can specify which patients you want to update. After checkmarking the patients you want to update, you can click the radio button for In Network, Out of Network or Unknown followed by the “Update Selected”. Clicking “Update Selected” will update each selected case with the corresponding values in the eligibility file for that patient on their insurance tab in the Co-pay section.
Additional options:
Adding Patients to the List Manually
You can add specific patients to the list if you would like using the Add to List function:
Clear and Retrieve Buttons
The Clear button will clear the patient list entirely if no or all of the checkmarks for the patient list is set. If some are checked, then the ones checked will be cleared. The Retrieve button will check eligibility for the checked patients.
Colors:
Clicking on a color box will allow you to change the color from the default color value to the one that you specify. “Reset to Defaults” button will reset the colors to the factory settings.
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