Eligibility Verification for Patient
Registration
On the patient registration screen, next to the
Insurance Fields, there is a button
labeled “E”. Use this to check on
patient’s eligibility status.
When you first click “E”,
the system will display any previous Eligibility requests. If you see a request that has a recent date, you can just click
on that link and see the document.
To get a new verification,
click on “CHECK”
Possible errors:
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Error
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Solution
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Missing Payer ID
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This particular insurance
does not have its Eligibility ID filled out.
Consult the InstaMed Payer list.
Example:
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Payer
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Elig ID
|
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Medicare So Calif
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MCCA00
|
|
Medicare No Calif
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MCCA01
|
|
Medi-Cal
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MDCA00
|
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Aetna
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60054
|
|
Blue Cross Calif
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BC001
|
|
Blue Shield Calif
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94036
|
|
Cigna
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62308
|
|
Healthnet
|
95567
|
|
|
Invalid/Missing
Subscriber/Insured name
Patient Not Found
Invalid/Missing Subscriber
ID
|
The payer cannot find this
patient. Double Check
·
Policy ID. You may need to add 01 suffix
·
Ploicy ID: Don’t use dash or space
·
Spelling of
Name. Use Robert instead of Bob
·
Birth Date
·
|
|
Unable to respond at
Current Time
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The payer’s computer
system is unavailable or busy. Try
again later
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|
|
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If the verification request
is successful, you will get a report on eligibility. Each payer sends a slightly different set of
information, thus the reports will appear different depending on the payer.
Important
items to look for within the responses.
Eligibility Response - Complete 05/26/2009 Information Source: AETNA INC PayID: 60054 Provider : MODERN MEDICAL GROUP NPI: xxxxxxx557 Subscriber: SMITH,MICHAEL ID:W104xxx664 4594 LA CANADA RD FALLBROOK, CA 92028 Group : THE WASHINGTON POST COMPANY Birthdate : 06/29/1959 Sex : M (307) Date Eligibility 01/01/2008-03/31/2009 Terminated (472) Date of Service 05/26/2009-05/26/2009 In Network Employee only Co-Payment $ 50 SPEC OFF VST Co-Payment $ 30 PHYS OFFICE VS In Network Individual Deductible Calendar Year $ 250 Benefit 01/01/2009 Deductible Remaining $ 225 Med Dent
|
Patients that belong to
HMOs, their eligibility will come from the HMO, but be sure to look for the assigned
IPA/Medical Group.
|
Aetna, Patient assigned to SCMG
|
Eligibility Response - Complete 05/28/2009 Information Source: AETNA INC PayID: 60054 Provider : MODERN MEDICAL GROUP NPI: 1346224557 Subscriber: SMITH MICHAEL ID:Bxxx8Q7A Group : SWEIG GENERAL CONTRACTING Plan : PO BOX 1494 SAN MARCOS, CA 92079 Birthdate : 04/09/1959 Sex : M (307) Date Eligibility 11/01/2008 (472) Date of Service 05/28/2009-05/28/2009 Health Benefit Plan Coverage Family Health Maintenance Organization (HMO) Primary Care Provider 11/01/2008 Prim Prov RODRIGUEZ GEORGE (760)291-6700 Primary Care Provider Name RODRIGUEZ, GEORGE J., MD ß Assigned PCP and Medical Group 225 E 2ND AVE ESCONDIDO, CA 92025 Primary Care Provider Name Sharp Community Med Grp - Graybill 8695 SPECTRUM CENTER BLVD FOUR SAN DIEGO, CA 92123 |
Medicare patients can choose
HMOs. If a response from CMS Medicare
lists an HMO at the end, then change patient insurance to the HMO, re-check
eligibility, so that you can determine which IPA/Medical Group to send your
insurance claims.
|
File:
3747896565.271
Eligibility
Response from Medicare - Complete 06/11/2009
Information Source: CMS PayID: MCCA00
Provider
: MODERN MEDICAL GROUP NPI: 1821081043
Subscriber:
BARNEY JEANETTE ID:548xxxx122C
1234
MAIN ST
ATASCADERO, CA
934226891
Birthdate : 02/02/1977 Sex : F
(307) Date Eligibilty
06/11/2009
Individual Medicare Part A
Active Coverage Date Eligibilty
07/01/2002
Individual Medicare Part B
Active Coverage Date Eligibilty
07/01/2002
Professional (Physician)
Medicare Part B
Deductible Remaining $ 0 Benefit
01/01/2009-12/31/2009
Other
Plan or Additional Payor
Information Source: HEALTH NET LIFE
INS PayID: MCCA00
Name HEALTH NET LIFE INS CO/HEALTH ß Assigned HMO
21281 BURBANK BLVD
WOODLAND HLS, CA 913676607
(800)806-8811
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