Creating a Request
An Eligibility request can be created using the "New" button on the Coverage Eligibility Main form.
A quick create form will slide out from the right side.
- Enter the patient's member Id.
- Choose from the list of Payors. Start typing to filter and find a payor.
- For a new patient, enter the patient's birth date, first name and last name. For a pre-existing patient use the Patient lookup field to find the patient's contact record. The patient's birth date, first and last name will auto-fill.
- Enter the start and end date that you wish to search coverage for.
- Enter the category of coverage you want to request.
An eligibilty request is also sent with a Submitter Id and Provider NPI. See below docs to understand how those are determined.
Upon Save you will be navigated to the Eligibility Request main form where you can review the detailed Response information.
Editing a Request
Using the "Modify and Resubmit" button on the Eligibility Request main form you can re-submit a request and modify the request information before sending to the payer.
If an error is returned by the payer, users can review the returned error information on the Eligibility Request main form.