Real Time Eligibility:
a cloud based patient eligibility verification tool. It has a basic login with username and password like other payer based web portals.
The layout of this tool has the patient demographic information as the first tab and the list of existing payers are mentioned below. Each provider is set up with their respective state and location. Eligibility can be verified for individual patients or in a batch using CSV excel format. The batch which is uploaded is automatically verified for eligibility and benefits using the patient data present in the excel sheet that runs in the background. Other eligibility criteria can be verified whilst making this tool a multitasker.
If the patient’s info is incomplete, it can run eligibility using only limited information, for example: only patient first or last name. It will automatically identify potential payers which have this patient’s name, out of which it can be determined the health policy the patient has.
Detailed benefit information like co-payment, coinsurance, deductibles are available for specialty specific healthcare professionals or organizations. The service type codes for example: Behavioural health, Oncology, DME, Dental management etc. are pre-set in a drop down format, so that speciality specific searches are categorized. There are around 235 STC which can be customized according to payer preferences.
Reports and Transmission:
Since this tool is not into denial analytics, the reports are with basic eligibility information. If batches are not available and need to be obtained from third parties, the SFTP feature is included and available for data transmission.
