Nirvana athenaOne Workflow
Nirvana Eligibility Checking
Automated Checking Workflow
Please reference the below workflow when reviewing Nirvana Eligibility. If you there are any issues with Nirvana and athenaOne please be sure to submit a zoho ticket to the EMR Team to resolve the issue.
1. In the Purple Main Menu Bar > Click CALENDAR > Navigate to the Eligibility & Phone List.
2. On Eligibility & Phone List page, use
the “Date” filter to change the date you need to review. Note: Nirvana will run
for visits 3 business days prior to the patient visit.
Mondays: check same-week Thursday
Tuesdays: check same-week Friday
Wednesdays: check following Monday
Thursdays: check following Tuesday
Fridays: check following Wednesday
a. Note: For any visits scheduled within the next 3 business days, Nirvana will run automatically after the appointment is scheduled. You will need to check the Eligibility & Phone List for any “New appointments added within the next 3 business days to see if there are any eligibility issues.
b. Note: If patient changes insurance AFTER Nirvana has already ran, you will need to “manually check eligibility using the Nirvana ops tool.” You will know they changed it, either by the patient communicating with you directly, or when they upload a new insurance card through Epion.
3. For any visits that will require eligibility work, the Appointment Notes field will contain a message beginning with the words “NIRVANA REVIEW” followed by a more specific message outlining what you need to do.
a. If an appointment has a “NIRVANA COMPLETED” message, you do not need to do anything for eligibility.
i. Continue to use credentialing spreadsheet to confirm provider is enrolled
ii. Primary results do not account for Secondary coverage
b. Use the “Nirvana Message Guide” document to remind yourself of what to do for each type of Nirvana message.
4. To update the patient policy, right
click on the blue “Policy”
Hyperlink and select “Open link in new tab”. Opening the
policy in a new tab will allow you to toggle back and forth between the
Eligibility & Phone list and policy to transfer over any benefits details
from Nirvana.
5. Update the Policy details as needed and click “Update Policy.” Close the tab and return to the Eligibility & Phone List.
6. To mark a visit’s eligibility review as complete, select the “Edit” hyperlink next to the Appointment Note. Delete the error message (everything in capital letters),and replace the capital letters with the word “DONE.”
a. Delete the error message (Everything in CAPS)
a. Replace with “DONE.”
***There are two scenarios where the benefit information (copay, coinsurance, remaining deductible) may come back with values that are not numbers. Here is what to do in those cases:
“n/a” this means the patient does not have a copay
or coinsurance.
“-“ (a dash) means that Nirvana was not able to obtain the amount. In this case, make sure there is a Card on File for the patient to ensure it gets charged after the visit. If you are unable to obtain a Card on File, then please call the payer to obtain the actual copay amount and collect that copay from the patient.
Using the Nirvana Ops Tool
Please reference the below workflow when using the Nirvana Ops Tool. If you there are any issues with Nirvana Ops Tool and athenaOne please be sure to submit a Zoho Ticket to the EMR Team to resolve the issue. The Nirvana Ops Tool was created so that you can run Nirvana checks for a patient ad hoc whenever you need.
1. Access the ops tool from this link (Also listed in Geode Bookmarks under "Geode Admin Tools): https://ops.geodehealth.com/portal-admin
2. Go to the “Patients Benefit Query” tab.
3. Enter the following info:
a. Policy holder’s DOB
b. Member ID
c. Plan name (the ID next to the plan name is the Athena plan ID)
d. The email address of the provider the visit is scheduled with (start typing the providers name in the box to search)
4. Click “Check Benefits”
**Nirvana
runs at 5 am every morning for the following week’s eligibility. Any
appointments scheduled between now and the 3 business-day mark will have eligibility
checked automatically. ** Some plans are
excluded from this list please refer to the error guide.
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