eclinicalworks Training Eligibility Tool The ADI eclinicalworks database utilizes the Navicure clearinghouse for all eligibility and benefits queries. Eligibility is scheduled to run each night for the next day s scheduled visits, and staff can also choose to run eligibility checks manually for batches of patients or individual patient accounts. Running Batch Eligibility Checks: From the Resource Schedule view, click the E at the top of the window. The Batch Eligibility window will open. The top left of the view allows the user to select a provider and/or facility name as well as the appointment date range. The top middle of the view allows the user to select a particular insurance group, insurance plan, or transmission status. Use the LookUp and Submit buttons to lookup scheduled patients and submit queries for eligibility and benefits. The top right of the view allows the user to select all insurances versus primary only, secondary only, or tertiary only, as well as filter by Eligibility Status.
To run a batch eligibility check for all scheduled patients on the following day, enter the provider name and date in the top left of the window and then select Lookup in the middle. The list of patients will appear below. The Status of Not Submitted and the Eligibility Note of Not Verified indicates eligibility has not ran for these patient accounts. To submit an eligibility query for all patients listed, click the Submit button in the top middle of the screen. The status bar will indicate eligibility is being processed. Click Ok to the submitted message.
The patient list should now update with new Eligibility Statuses and Notes. A message of Received and Yes indicates a message was received back from the clearinghouse and the patient is eligible. For any patients with Not Verified indicated in their Eligibility Notes column, click the patient line to view the error message and resubmit as necessary. Users can choose to resubmit only Not Verified statuses by using the Eligibility Status filter and Lookup button at the top of the window. For all patients with Received and Yes indicated, click the patient line to view eligibility and benefit details. The Summary view will indicate patient demographic details, coverage start dates, subscriber ID and group numbers as well as insured relationship details. Expand the tabs for Coverage, Coinsurance, Co-Payments, and Deductible to view more specific information.
Sample Views: For this patient with Blue Cross Blue Shield, the expanded Coverage tab indicates the patient has Medicare Primary and their BCBS plan is a PPO BC 65 plan. The Co-Payment tab indicates the patient has no copay for PCP and Specialist Office Visits. Sample View: For this patient with Medicare A&B primary, the expanded Coinsurance tab indicates the patient s 20% responsibility. The Deductible tab indicates the patient has $130.08 remaining of their $183 Part B deductible.
Sample View: For this patient with HealthSpring primary, the expanded Coverage tab indicates authorization is required for specialist visits and the name of the PCP on file. The expanded Co-Payment tab indicates no copay required for PCP visits, but a $75 copayment for ER visits and $40 for in-network specialist visits.
Running Eligibility on Individual Patient Appointments: From the open patient appointment window, click the Check button under Insurance Eligibility. The Eligibility window will open and indicate the request is being processed.
Close and reopen to view the final eligibility report. Viewing Eligibility Status from the Resource Schedule: The Resource Schedule will indicate eligiblity status with a Y, N, or? to the left of the patient name. These statuses will update after scheduled eligibiilty checks and manually completed eligiblity checks.
Common Eligibility Error Messages No Insurance Loaded: The user will receive a No Insurance present message when attempting to run eligibility on a scheduled visit where insurance has not been loaded. Missing Subscriber Information: When only partial or incorrect patient insurance information has been loaded, the Eligiblity Report window will indicate Invalid/Missing Subscriber ID. Terminated Coverage: When the eligibility check was successful but the patient s coverage has termed, an N will appear to the left of the patient name on the Resource Schedule, and the Eligibility Report will indicate the eligibility end date.