Eligibility Verification

Eligibility Verification provides a way to view 271 Eligibility Verification File information.

Go to Billing > Eligibility > Eligibility Verification.

Electronic 271 Eligibility Verification File: Specify the location and name of the 271 eligibility verification file you received from the payer or click on the yellow folder to browse to the file location.

Insurance Selection: Select the insurance from who you received the 271 eligibility verification file.

Process Options:

Report Non-Eligible Patients Only: Select this option to show only patients who are not eligible for the payer.  Eligible patients will not be displayed on the report.

Edit Patient Name: Select this option to show patient name mismatches.

Exclude Bad Patients: Select this option to not show patients who aren’t found in the patient file.

Select Preview or Print to review the report.

 

Sample Report:

The Reformat button provides a means of adding a Carriage Return/Line Feed to a claim or response file for easier file viewing. Can also be used for improperly formatted 835 electronic remittance files prior to posting.

Input File: Specify the path where the file resides or click the ellipsis button to browse to the file location.

Input File Type: Select “Specify Special Delimiter”

Delimiter: Enter the character used as a delimiter in the Input File. The most common delimiter is a tilde (~).

Output File: Specify the location and filename for the reformatted file (Note: the output filename and location cannot be the same as the input filename and location. Change the output file to a different name if needed).

Records Need CR/LF: Select this option to add a Carriage Return/Line Feed.

Add Delimiter to Record: Select this option if CR/LF is used as the file delimiter to remove extra CR/LF from a remittance file prior to electronic remittance posting (i.e. for payers whose files are formatted this way, such as HMSA).