1. Practice Insight Instructional Webinar Series Eligibility Manager
Presented by:
Shaun McAnulty – Product Training Specialist

2. Key Items Eligibility Cycle Eligibility Formats Submission Methods
What is Eligibility Manager
Editing Eligibility Requests
Enhanced Eligibility- Beta
Questions

3. During testing requests can be marked Invalid.
Eligibility Cycle
During testing requests can be marked Invalid.

4. Eligibility Formats ANSI 270 File from Practice Management Software
Proprietary Eligibility Flat File
Add-One button in Eligibility Manager
Response Formats
ANSI 271
HTML (New format available)

5. Submission Methods Manual
Automated
(270 or Flat File)
Manual
HTTPS: An individual request is submitted with a payer response returned.
SFTP: Batch mode sends multiple requests and the 271 responses are posted in a response directory for pick up by your Practice Management System.
Using the Upload Files button.
ADD-One: Manually enter eligibility information and submit a request.
On-Demand from a Claim.

6. Eligibility in Claim Manager
Any claim with a RED E will allow you to run a Real-Time Eligibility check if the option is turned on. Simply hit E for Eligibility or use your Right Click feature and the Response is returned.

7. What is Eligibility Manager?
Is the main location where users can search, work, edit, view and add eligibility requests.
All responses and request history are also located here to view at any time.
The layout is similar to Claim Manager.

8. F1 Online Help
Some questions you may have about the application may be answered in the online help guide!
Each subsection is broken down and shows field descriptions and definitions.
Allows keyword searching

9. Using these fields can aid in returning results!
ADD-One
Using these fields can aid in returning results!
Eligibility Request can be added manually by clicking ADD-One button
All Required fields are designated by an * (in yellow)
Practice Insight creates 270 to send to payer
Then a Response is displayed

10. Eligibility Response With conflicting data displayed in Red*
Display the 271 in user friendly format
Stylistic and consistent layout based on what the payer sends back.
With conflicting data displayed in Red*

11. Eligibility Invalids & Rejects
Rejected
Invalid requests are never sent to the payer
Caused by missing required data
Common invalid reasons
This payer isn’t setup for eligibility
Subscriber name and ID number not entered
No provider selected
Provider not enrolled for CMS eligibility request
Sent to payer and rejected for reason given
Common rejection reasons
Unable to respond at the current time please resubmit the transaction
Subscriber/ insured not found
Patient not covered
Incorrect member ID

12. Overview
MANAGE Enrollment: Will allow user to setup a providers username/login for payer websites for Enhanced Eligibility.
UPLOAD file: Button brings up a dialog box where the user can select a 270 / 271 file, or a CSV flat file to upload into the EDI software.

13. SELECT Records: Displays eligibility requests based upon the criteria entered in the fields of the Eligibility Selection Criteria View.
CLEAR Selections: Allows the user to clear all information from the Eligibility Selection Criteria fields.
DOWNLOAD 271: Allows the user to create a batch 271 response file to return to the Practice Management System.
All selected records in the Eligibility List View can be batched into a 271 and downloaded to the local PC. This file can be loaded into the Practice Management System if the software has the ability to import and read the ANSI 271 transactions.
PRINT Detail: Displays the complete, printable report of the Eligibility and Benefit Information for each selected eligibility request.
PRINT List: Allows the user to print a list of all selected eligibility requests in the Eligibility List View.
Information on the Eligibility Request List includes the EDI ID, Eligibility Request Status, Patient Name, Payer ID, Co-pay Amounts, Primary Care Provider, Coverage Status, and Date of Service.

14. ADD One: Allows the user to manually add an eligibility request.
Fields with an asterisk ( Payer ID, Provider ID, Service Type, Last Name, First Name, and Member ID ) are required fields.
EDIT: Allows the user to edit an existing eligibility request.
REALTIME Check: The user can manually check the real-time status of the selected eligibility request.
Once the check is complete and the 271 is received back from the insurance payer, the Eligibility and Benefit Information screen will appear.

15. VIEW Change Log: Displays a report that shows all of the changes that have been made to a specific eligibility request.
This report also shows the full history of the eligibility request at the bottom.

16. Right Click Options Options in Selection View
Options for Status Message View

17. Helpful Tips & Uses
Task Manager* can be paired with Eligibility to work all your invalid & rejected requests easily.
Using the Print List button when selecting an upload file for a specific day allows you to print a quick check in sheet for front office use.
The list of active Eligibility payers can be found by pressing [F4] on the Payer ID field or by printing a list via Search Tools
*If you don’t currently have Task Manager (Customers= contact your Vendor)
(Vendors= contact your support representative at Practice Insight)

18. Task Manager
With Task Manager users can easily build Eligibility tasks to monitor, work, and organize their 270/271’s.
Most common Task for Eligibility would be Invalid & Rejected Eligibility Requests.
You can also build Tasks to pull a specific upload date.

19. Enhanced Eligibility
We can use a Providers Login on the Payers website to return Eligibility responses.
Manage Enrollment is where you are able to enter and manage individual login and passwords for Payers websites which we use to access the eligibility information. We are currently in Beta-testing if interested please let your vendor know.

20. Question and Answer

21. Who To Contact
Customers: If you do not have Eligibility Manager or have any further questions on Eligibility Manager please contact your Vendor
Vendors: Contact your Practice Insight support representative with any questions on todays webinar.

22. Survey Your chance to give feedback Request new topics
Ask other questions