Overview 

ICANotes+ provides the capability to verify insurance eligibility for clients through two methods: Individual and Batch Processing. This feature covers all insurance types - primary, secondary, and other insurances. During the eligibility verification process, you can also view the date of the last eligibility check performed. Logs for these checks are available in the Practice Logs section. In the event of an error during eligibility verification, a notification appears on the Notifications screen.

Prerequisites 

Please contact our Sales team to sign up for the Insurance Eligibility Verification feature for your practice.

Locate the "Eligibility ID" Field in Payer Settings and Insurance  

When adding an insurance payer in the system, locate the Eligibility ID field as shown in the screen below. This field is used by the clearinghouses to map an eligibility request with the specific payer. Navigate to Settings > Practice Settings > Payer Settings to locate the Eligibility ID field.

When adding client's insurance details, the Eligibility ID will automatically populate upon selecting payer from the list.

Note: When you add an Eligibility ID for a payer, it will automatically appear in the insurance section of all clients associated with that payer, eliminating the need to enter it individually for each client.

Essential Fields Required for Validating Eligibility

In order to successfully verify insurance eligibility for clients, it is imperative to document information in the following fields:

Practice Information section

• Practice Name 
• Place of Service Code
• NPI 

Insurance section

• Member ID / Policy Number
• Legal First Name
• Legal Last Name
• Primary Insured Legal First Name
• Primary Insured Legal Last Name
• Eligibility ID

Assign Permission to Verify Eligibility / View Eligibility Response 

Only the authorized users can verify insurance eligibility for the clients. The practice administrator must assign permission to authorized users to verify the eligibility.

To manage permissions, navigate to Settings > Practice Settings > Roles & Permissions, and then click on the Edit button as illustrated below.

On the Update Role screen, within the Eligibility section, you can find the following permissions:

• Verify Eligibility: Select this checkbox to assign permission for verifying eligibility. The users with this permission can verify insurance eligibility for the clients.
• View Eligibility Response: Select this checkbox to assign permission for viewing the eligibility response. The users with this permission can only view the eligibility response received from the clearinghouses. They cannot verify eligibility for the clients.

The users who do not have permission will see the tooltip upon verifying insurance eligibility for the clients. Refer to the screen below:

Conduct an Insurance Eligibility Check Directly from the Calendar 

When scheduling appointments for your clients via the calendar, navigate to the Insurance Information section, where you can view all the insurances associated with the client, including primary, secondary, and other coverage. Choose the relevant insurances and then click the Check Eligibility button to confirm the client's insurance eligibility.

Note: When eligibility verification is in progress, the Check Eligibility button will appear disabled on the screen. This is to avoid users clicking on the button repeatedly when the verification is already in progress.

When the eligibility check for the client has never been performed before for a specific Insurance, you will see the message "Eligibility has not been checked", as shown in the screen below.

When the eligibility check for the client has been performed for an insurance, you will see the processing icon indicating that the eligibility check is in progress, as shown in the screen below.

Once the eligibility check for the client has been performed successfully for an insurance, you will see the green check icon indicating that the eligibility check is successfully completed, as shown in the screen below. You can also locate the date and time when the eligibility was performed.

In case when the eligibility check for the client is failed for an insurance for some reason, you will see a failure message with an icon, as shown in the screen below. You can also locate the date and time when the eligibility was performed.

Perform Insurance Eligibility Check from the Billing Tab 

You can also perform the insurance eligibility check when accessing the client's chart details. On the client's chart, navigate to the Billing tab, locate the Eligibility panel as shown in the screen below.

Select one or more insurances from the list and click the Check Eligibility button.

When eligibility verification is in progress, the Check Eligibility button will appear disabled on the screen. This is to avoid users clicking on the button repeatedly when the verification is already in progress.

Perform Insurance Eligibility Check for a Group of Clients (Batch Eligibility)

You can verify eligibility for a group of clients at once. To verify eligibility for a group of clients, navigate to Calendar and click the Check Eligibility button as shown below:

On the Check Eligibility screen, you can filter the clients based on their appointments, clinician, and eligibility status. 

• Appointment Start: Select the appointment start date using calendar icon. You can verify eligibility for next seven days from the appointment start date.
• Appointment End: Select the appointment end date using calendar icon. Based on the appointment start date, the date selection for appointment end date will appear. If you have selected appointment start date as 04/01/2024, you can select up to 04/08/2024 as appointment end date.
• Clinician: Select clinician from the dropdown. Only clients assigned to this clinician will appear in the list.
• Eligibility Status: Select eligibility status from the dropdown. Only clients with the selected status will appear in the list.

You can select one or more clients from the list to verify the eligibility and click the Check Eligibility button, as shown below:

Note: When eligibility verification is in progress, the Check Eligibility button will appear disabled on the screen. This is to avoid users clicking on the button repeatedly when the verification is already in progress.

Execute Batch Eligibility Maximum for Up to 50 Clients Simultaneously    

When verifying insurance eligibility for multiple clients, you can choose a maximum of 50 clients simultaneously. To include additional clients, you'll need to clear out some from the batch. When you try to select more than 50 clients, a tool tip will appear as shown in the screen below:

Check Eligibility Request Status and View Response Summary 

When you check insurance eligibility for the clients, status will appear with the different tags as shown below:

The Pending status indicates that the eligibility check is currently processing. Once processed, the status will change.

The Active status indicates that the eligibility check is processed successfully and the client is currently covered.

The Failed status indicates that the service is unavailable. You may try again. If the error still persists, you can contact our customer support team.

The Inactive status indicates that the eligibility check is processed successfully and the no active coverage is found for the client.

In the following example, you'll find the client's active coverage by navigating to the Billing tab > Eligibility section. When you access the Eligibility Response section, you can view Copay, Deductible, Co-Insurance, and Out of Pocket Maximum at the top of the coverage details.

Verify the Last Time the Eligibility Was Checked (for a Single Client) 

You can check the last eligibility performed details for a single client as shown in the screen below. On the Calendar, an icon will appear next to the booked appointment. When you hover mouse over this icon, the tool tip will appear to display the last eligibility check details.

Verify the Last Time Eligibility Was Checked (for a Group of Clients) 

You can review the details of the last eligibility check for a group of clients, as depicted in the screen below. When using the calendar to select appointment dates and other parameters for the search operation, a list of clients will appear, displaying the date/time of the last eligibility check, as shown below.

Access Practice Logs to View Eligibility Verification Details 

Whenever the client's insurance eligibility is performed, the system generates a log for this action. You can review these entries in the Practice Logs section.

1. Navigate to Settings from the left sidebar.
2. Choose the Practice Settings tab at the top.
3. Select the Practice Logs option from the left pane.
4. In the Action Category dropdown, select Eligibility.
5. In the Action Subcategory dropdown, select Eligibility Check.
6. Click the Search button to proceed.

Instances of Errors Encountered During Eligibility Verification Process 

Upon receiving a response from the clearinghouse regarding eligibility, it may either confirm success or reveal errors. These errors, based on the clearinghouse response, will be displayed within the Billing tab under the Eligibility section, as illustrated in the following screenshots.

Alert Clients About Errors During Eligibility Verification 

In the event of an error during eligibility verification, users will receive a notification on the Notifications screen, as indicated below.

Watch the Video

FAQs 

You can find the Frequently Asked Questions (FAQs) on our Knowledge Base page.

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Need additional assistance?

Phone: 443-203-5857 

Text: 866-301-0085

Email: ticket@icanotes.com

Chat: http://app.icanotes.com 

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Proprietary Notice Information: This article is provided for informational purposes only, and the information herein is subject to change without notice. While every effort has been made to ensure that the information contained within this article is accurate, ICANotes cannot and does not accept any type of liability for errors in, or omissions arising from the use of this information.