Manually Update Eligibility from the Quickview

Manually Update Eligibility from the Quickview

Manually Update Eligibility from the Quickview

The Eligibility Detail page allows you to verify a patient's insurance eligibility for participating insurance plans, as well as verify a patient's insurance eligibility as of a prior date of service. The athenaNet system retrieves this information from insurance carriers that provide eligibility information electronically whenever the payer sends it to us via the ANSI standard transaction.

You can also resolve eligibility demographics conflicts that occur when the information on file in your practice (name, address, ID number, etc.) is different from the payer's information.

                                                         How do I get to this page?

On the Patient Actions Bar, click Registration, and then click Check Eligibility. If the patient has only one policy registered in athenaNet, the Eligibility Detail page appears

On the Quickview page, under the Insurances heading, click view detail or click Perform eligibility check

    To perform a manual eligibility check for a patient policy

                       If you need to manually update the eligibility status per the payer, please review the following:

                                                    

 

          1.    On the Quickview page (Insurances section), click the Update this policy link under the specific policy.

          2.    On the Update Policy Details page, click Update & Check Eligibility.

          3.    The Eligibility Detail page appears with the current results for the policy.


          4.    Scroll down to the Eligibility Section and take action on the policy by clicking on ”Override payer-returned result”.

  a.    Set the  “New status” to Eligible

                     b.    Set the “New Reason” to one of the options from the drop down for both.

  c.    If you confirm this information with a live agent from a payer call please document this information in the Notes section of the policy.

         5.    Click “Update Policy”.

           To view eligibility information as of the last eligibility check

                                 You can check the latest eligibility information retrieved from the payer as follows:

        1.    On the Quickview page (Insurances section), click the view detail link under the specific policy.

        2.    On the Update Policy Details page, click the View eligibility detail link next to the Last eligibility message field.

        3.    The Eligibility Detail page appears. If the patient has more than one policy registered in athenaNet, you can:

        4.    Click the View Eligibility Summaries link on the Eligibility Detail page to display the Eligibility Summaries page.

        5.    Click the View Eligibility Detail link on the Eligibility Summaries page to return to the Eligibility Detail page.

                    To resolve eligibility demographics conflicts

Note: If there are eligibility conflicts, a warning message appears on the Quickview: Demographics conflict: Click view detail to resolve.

  1.   Display the Eligibility Detail page: On the Quickview page, under the Insurances heading, click view detail or click Perform eligibility check.
  2.    Review the list of conflicts listed in red.
  3.    Click Update in athenaNet to update an individual item or click Update All in athenaNet to update all the conflicting data items. A dialog box appears: "Are you sure that  you want to update this policy?"

  Note: The Update buttons on the Eligibility Detail page synchronize patient demographic information between the practice and the insurance company for the insurance policy only. The Update buttons do not  update the patient data on the Quickview, Patient Registration, or other athenaNet page.

  4.  Click OK to update the conflicting values on the policy.


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