Check Insurance Eligibility List and Perform Electronic Eligibility

The Insurance Eligibility List proves valuable to insurance verifiers and staff conducting insurance eligibility checks. Within CareStack, this feature enables you to ascertain the status of the patient's insurance plan.

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Topics Covered

• Track and Manage Insurance Eligibility
• Set Up Insurance Eligibility List Criteria
• Configure Electronic Eligibility Settings

Track and Manage Insurance Eligibility

Explore this video for an in-depth walkthrough.

• Navigate to Lists > Insurance Eligibility List.

• Select the desired Appointment Date and Appointment Location to obtain the list of the patients who have an appointment and require an eligibility check.

You can narrow down the items in the grid by utilizing the following tabs:

• All Insurance with Pending Eligibility
• Insurance Requiring Manual Eligibility
• Insurance with Electronic Eligibility 
• Electronic Eligibility Response Pending Review
• Draft Insurance

Note: Under the All Insurance with Pending Eligibility section, you can view all insurance with pending eligibility.

• The Insurance Requiring Manual Eligibility tab includes insurance plans that require manual eligibility verification. This involves contacting the carrier or accessing their portal and updating eligibility based on available details.

To view insurance eligible for electronic eligibility, and to perform electronic eligibility:

• Select the Insurance with Electronic Eligibility tab.
• Select the desired insurance from the grid.
• Click Perform eEligibility.

• Select the Billing Dentist for Electronic Eligibility and Service Type Code.
• Click Proceed.

Note: Your patients will then be sent out to the clearinghouse, which will communicate with the insurance company to get that information back.

• Once the electronic eligibility check is completed, you will find the corresponding insurance moved to the Electronic Eligibility Response Pending Review tab, where you can view ‘E-Awaiting’ or ‘E-Response.’
  • Ensure to Verify and update the items, as required.

• Select the Draft Insurance section to view patients with pending eligibility in insurance plans that do not have sufficient information to be confirmed as active and are in the early stage of verification.
  • Ensure the necessary action is taken as needed to confirm the patient's eligibility for insurance coverage before any dental services can be provided.
  • Click Update to add the required information.

Set Up Insurance Eligibility List Criteria

Watch this video for a quick walkthrough.

To set up the Insurance Eligibility List criteria, perform the steps below.

• Navigate to Lists > Insurance Eligibility List.

• Click on the Settings button.

Under the Insurance Eligibility List tab,

• Click Edit.

• Set up the following worklist criteria for the Insurance Eligibility List:
  • Default View for Eligibility List: Enter the time period in days to display the Patients who have scheduled appointments within that period.
  • Under Eligibility Check Period, choose how you want to apply the eligibility check period. You can set the same rule for All Plan Types or define them Individually. 
  • All Plan Types: Apply the same eligibility check rule to all insurance plan types.
    • Requires Eligibility Check After: Ensure to click the dropdown and choose one of the following options: Calendar Month, Calendar Year, Fiscal Year, Custom Period.

• Each Plan Type Individually: Apply custom eligibility check rules for each insurance plan type. You can specify how often eligibility needs to be verified for each plan type.
  • Choose one of the following options: Calendar Month, Calendar Year, Fiscal Year, Custom Period.
• Click Save after setting up the worklist criteria.

Configure Electronic Eligibility Settings

Watch this video for a complete understanding.
 

To schedule electronic eligibility and initiate auto verification of eligibility, perform the steps below.

• Navigate to Lists > Insurance Eligibility List.

• Click on Settings.

• Select the Electronic Eligibility tab.
• Click Edit.

Schedule Electronic Eligibility (eEligibility)

• Click on the toggle button on the Schedule eEligibility section to enable it.

Tip: By enabling this, an Electronic Eligibility Request would be scheduled for every patient based on the criteria you have chosen.

• Set the trigger criteria for 'Patients with pending eligibility who have appointments in next X number of days'.

• You can choose to set the eEligibility based on an Account level or Location level.

For Account Level, configure the following:

• Default Provider For eEligiblity Request
• Default Billing Provider
• Service Code

For Location Level, configure the following:

• Enable the required Locations of the practice.
• Select the Default Provider For eEligiblity Request.
• Choose the suitable Default Billing Provider.
• Select the Service Code.

Note: A default billing provider will be used to perform eEligibility if the primary appointment provider is a hygienist.

• Once done, click Save.

Initiate Auto Verification of Eligibility

You can enable the auto verification of eligibility which will prompt the system to update the eligibility of the plans whose carrier supports Electronic Eligibility automatically.

To set auto verification of eligibility:

• Click on the toggle button on the Auto Verify Eligibility section to enable it.
• Choose the Supported Carriers for the insurance.
• Checkmark the required fields to be updated during auto-verification.
  • Plan Status: Update the plan status as Active Or Inactive.
  • Effective Dates: Update the effective date of the plan.
  • Patient & Subscriber Details: The ID of the subscriber.
  • Deductibles: Update the plan deductibles and remaining.

• Once done, click Save.

Practices can use this guide to learn how to track and manage the Insurance Eligibility List in CareStack.