In this article, you'll learn about our updates to:
- RCM: Extended Eligibility results display and improved navigation
- RCM: The name of the original claim submitter displayed in Claim History
Extended Eligibility results display and improved navigation
Earlier this year, we implemented a feature allowing you to check patients' eligibility to verify their coverage and benefits directly with the insurance provider. This helps reduce the risk of billing errors and ensures services are covered by the patient's insurance plan. Additionally, checking eligibility upfront allows for estimating coverage and patient responsibility based on copay, coinsurance, and deductible details.
With the latest release, we've enhanced the Eligibility checks by providing more comprehensive details and introducing convenient navigation.
Upon completion of the Eligibility check, simply click on Details to review the full results:
Navigating Eligibility check results
Along with the basic patient details, you'll now see convenient breakdown of different kinds of benefits. Unfold any tab to see the detailed information.
Please note:
The list of benefits and the overall amount of data may vary from payer to payer. For each Eligibility check, you may be getting a slightly different set of tabs and results, depending on what's being provided by the given Insurance company.
Below are a few examples of the benefits to look into if provided by the payer:
1. Verify the coverage dates, covered services and other plan details under Active Coverage,
2. Verify the applicable Co-Payment and Co-Insurance amounts for various service types,
3. Turn to the Deductible tab details to view applicable amounts for the calendar year, amounts paid to date, and remaining balances,
4. Check for plan Limitations and Out Of Pocket amounts.
Reviewing the original response from the payer
At times, a payer may return some extra, non-standardized information that cannot be reflected on the user interface. Now, you also have the option to review the original response as received from the payer.
1. Upon looking through the benefits, click on the three dots next to any to see an excerpt form the original payer response associated with this particular benefit,
2. To review the full response as returned by the payer, click on View Original File at the top right corner. Open the downloaded .json file in any text editor (e.g.: Notepad).
Contacting the payer to verify additional details
Some payors may include contact details directly into the Eligibility results.
If you require further clarifications on eligibility and benefits, check if the Eligibility results happen to have a Contact Following Entity tab with payer-suggested contact information.
The name of the original claim submitter displayed in Claim History
The History & Notes tab of each Claim will now show the name of the person who submitted the claim - right next to the Submit Initiated event on the list.