Billing / Eligibility

Is the patient covered? Asked before the visit, not discovered after the denial.

Record each patient’s cover, ask the payer before the visit, and keep the answer against the appointment. Nobody is ever shown as covered when nobody checked.

Try it in the live demo All modules

The Eligibility page: insurance on file with “Record a phone check” for each patient, and recent checks — one patient not covered today, others covered with their plan, copay and deductible remaining. — Whether a patient is covered, and what they will owe, before they are seen. Shown with sample data.

What it does

Eligibility, in practice

Insurance on file

Payer, payer ID, member number, group and the dates the cover runs, for each patient. Member numbers are encrypted, and lists show only the last four digits.

A telephone check that counts

Ring the payer and record the answer — covered or not, copay, deductible left, plan, and who confirmed it. It counts on the claim exactly like an electronic check.

The payer’s own format, when connected

With a clearinghouse connection, a check goes out as an X12 270 and the 271 reply is read back into cover, plan, copay, coinsurance, deductible and the plan’s start and end dates.

Cover that has ended

Once an end date is on file, from a 271 or typed in, a visit after it is flagged on the claim and the patient’s cover shows when it ended.

“Not covered” is not “no answer”

A rejected question or a failed check is never shown as covered — and never as uninsured.

Paste a 271 from anywhere

A response from a payer portal or an email can be pasted onto a pending check.

Clears the claim warning

An answered check for the visit date satisfies the claim rule that cover was never checked.

How it works

From the first step to the last

1
Record the cover
Add the patient’s insurance at booking or at the desk.
2
Ask before the visit
Electronically where a clearinghouse is connected; otherwise by phone, writing down what the payer said.
3
Tell the patient
Somebody not covered on the visit date hears it before they are seen, not on a bill.

What it needs

Before you switch it on

An EMR connectionWorks with ONEemr, with OpenEMR, or with another EMR through the Bridge.

Every module switches on and off by itself, per clinic, with its own screens, permissions and audit trail.

Worth knowing

Electronic checks need a connection to your clearinghouse, and no clearinghouse connector ships yet — so today checks are recorded by telephone, exactly as the screen above shows.

Goes well with