12/13/2023 Release Notes (2.0)

In this article, you'll learn about our updates to:

• • RCM: Checking patient's insurance eligibility 
    • How to activate eligibility checks
    • How to submit eligibility checks
    • How to view eligibility check results
    • How to view eligibility check details
    • How to use eligibility history
    • How to interpret eligibility check errors
    • How to view the number of submitted checks per practice
  • EHR: Hiding providers with inactive or expired schedules from the Calendar

Checking patient's insurance eligibility

Eligibility verification is the process of checking a patient’s active coverage with the insurance company to verify information such as coverage, copays, deductibles, and coinsurance.

Patient’s insurance information can change at any time, potentially causing claim rejection or denial, so it's important to verify patient’s coverage before every appointment and before submitting claims. This verification helps to ensure that the patient's insurance information is accurate and up-to-date, reducing the risk of billing errors or providing services that are not covered by the patient's insurance plan.

How to activate eligibility checks

The Eligibility Check feature is provided at an additional cost - please reach out to support@remedly.com for pricing information.

Once contracted to receive this feature, the enrollment is required with each payer for submitting eligibility checks. This process may take some time for setup and some payers do not provide this service.

How to submit eligibility checks

Eligibility checks can be done from the insurance policy for each patient. In order to submit an eligibility check, follow the steps below:

1. Choose the patient and the insurance policy you would like to submit an eligibility check for:

If you're in the EHR:

a) Open the patient's profile:

b) In the Insurance tab, select the Insurance policy you would like to submit an eligibility check for:

Note: You will be redirected to the RCM module.

If you're in the RCM:

a) Open the patient's profile:

b) In the Insurance tab, select the Insurance Policy you would like to submit an eligibility check for:

 

2. Under More Actions, select Check Eligibility:

 

4. Complete the additional input fields as requested: select a Provider with NPI + Service Date, or Provider with NPI only. Hit Check Eligibility:

5. You'll see a notification that eligibility check has started. The status (processing...) will show up in the Eligibility preview tab:  

 

How to view eligibility check results

Once the eligibility check is completed, you'll see a preview of the most recent check:

• the date the eligibility check was submitted,
• the actual Plan/Coverage Dates registered by the insurance company,
• the status of the eligibility check. 

Note: If the status of the eligibility check is Failed, the preview will disappear once you leave the page, but the information on the check will remain in the Eligibility History.

How to view eligibility check details

To review the detailed eligibility check results, click on Details in the preview:

The results will open in a separate tab, showing such details as:

• Active Coverage
• Co-Insurance
• Co-Payment
• Contact Details
• Deductible
• Limitations
• Out of Pocket

From this tab, you can print eligibility check results for your records if needed.

Note: The results of previous eligibility checks can be found in Eligibility History.

How to use eligibility history

Reviewing the history of eligibility checks allows providers to verify when an eligibility check was last performed for the patient, and by whom.

Eligibility History is available for each insurance plan under the More Actions button:

Here you can find all relevant information on previously submitted Eligibility Checks:

• Date and time it was submitted
• On behalf of which provider the check was performed
• The plan/coverage period provided by the insurance company
• The status of the check
  • Completed - the results are available for review
  • Failed - the payer or the clearinghouse responded with a rejection message
  • Error - the system wasn't able to submit the check successfully
• Who requested the eligibility check

From the Eligibility History menu, you can review responses from the payers for the old checks that have the Completed status. Click on the check date, and the results will open in a separate tab:

The results of the any eligibility checks can be printed from Eligibility History as well:

1. Click on the three dots next to the corresponding check, and click Download PDF:

2. The print preview will open:

You can also view the reasons why certain previous checks failed. Such checks would have the Error status in case of any submission errors, or Failed status in case the check has been rejected on the insurance's side.

1. Click on the check date of the failed check to view the Error Details (use the Print option if needed):

2. Alternatively, click on the three-dot menu next to the failed check to Download PDF and review the Error Details in it (use the Print option if needed):

 

How to interpret eligibility check errors

When an eligibility check is submitted to a payer, errors or issues can occur for various reasons. Some common reasons for errors in electronic eligibility checks include:

1. Data Entry Errors: Mistakes can happen during the data entry process, leading to inaccuracies in patient information or insurance details. Even a small typo in a patient's name or insurance ID can result in an error.

2. Incomplete Information: If the practice does not provide all the necessary information required for the eligibility check, the payer's system may not be able to process the request correctly. Missing or incomplete data can lead to errors.

3. Outdated Information: Insurance information can change frequently, and if the practice is using outdated or incorrect insurance details, the eligibility check may produce errors. Keeping patient information up to date is crucial.

4. Mismatched Information: If there is a discrepancy between the information provided by the practice and the payer's records, errors can occur. This can happen if the patient's name, date of birth, or insurance details do not match what the payer has on file.

5. Authorization Requirements: Some insurance plans require prior authorization for certain services. If the practice does not obtain the necessary authorizations before submitting the eligibility check, it may receive errors indicating that the service is not covered.

6. Payer-Specific Rules: Each payer may have its own specific rules, coding requirements, and eligibility criteria. Failure to adhere to these payer-specific rules can result in errors when submitting eligibility checks.

When your eligibility check returns one of the errors listed above, the check status will be Failed and will show the error text:

Note: The preview of a Failed eligibility check will be removed once you leave the Insurance tab, or updated with the most recent successful check. The failed checks details remain under Eligibility History.

How to view the number of submitted checks per practice

Understanding how many eligibility checks are submitted monthly is essential for effective revenue cycle management, compliance, cost control, and overall operational efficiency. This information helps making informed decisions, allocating resources wisely, and ensuring services are being provided to patients with valid insurance coverage, ultimately contributing to financial stability and quality patient care.

The Eligibility Checks report providing these insights is available in the Reports tab in the RCM.

Download the Excel file to review details on all submitted checks including general information.

To learn more about Eligibility Checks, please view the article below:

• Check Patient's Insurance Eligibility (RCM)

Hiding providers with inactive or expired schedules from the Calendar

The All Columns view in the Calendar displays available practitioners within each role and department, showcasing their working hours, available booking times, and booked appointments.

Previously, in the default All Columns view, all practitioners with a schedule set up in their profile appeared on the Calendar, even if the schedule's applied period has reached its expiration date.

With this update, practitioners whose schedules have been removed or have expired will be hidden from the default All Columns view.

However, it might happen that some appointments have been booked or time slots have been blocked before the schedule expired, got removed, or its applied period got changed manually.

In this case, all booked appointments and blocked time slots will remain visible on the Calendar. The practitioner will only show up in the All Columns view for the corresponding dates.