Checking Third Party Payer Eligibility

Access the Third Party Tab within the patients account
Double Click on the Active Payer
The Payer Enrollment box will appear

While still on the Payer Enrollment screen, click on Eligibility button and the following screen will display..

• In the Eligibility Check screen, you will be asked to select either Real Time Electronic Eligibility Check or Manual Eligibility Check.
• Select Real Time Electronic Eligibility Check.

• Click on Start Electronic Eligibility Check and the system will contact the coverage carrier electronically to determine eligibility.
• A report will appear in a new screen.

*The Eligibility, Coverage or Benefit Report might vary among different providers and at first seem long and complicated. You will be looking for the Subscribers’ Name, Group or Policy Number, Eligibility or Benefit (including the type and description of the Plan), and Eligibility Begin and End dates.

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The system will automatically determine whether there is active coverage or not and post it to the Eligibility screen for you.

Payer status should be verified for all established patients and before services are rendered to a new patient.

Once eligibility has been determined, a response should be posted to the account.

If coverage is determined as “INACTIVE” the patient should be enrolled as PRIVATE PAY and the patient should be notified.

lp revision 2.3.16

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