When to use the standalone form
Sometimes you need to check eligibility before you have a claim in the system. Maybe you are verifying coverage for a scheduled transport, or you want to check a patient's benefits before their next appointment. The standalone eligibility request form lets you do this without creating a claim first.
How to create a request
- Click Eligibility in the menu.
- Click New Eligibility Request.
- Select the payer you want to check with.
- Enter the subscriber's first name, last name, Member ID, date of birth, and gender.
- Enter the service date — the date the service will happen or already happened.
- Click Create Request.
Creating a request builds a 270 EDI file and downloads it to your computer. Send that file to the payer or clearinghouse you use for eligibility checks. The request shows up on the Eligibility page with a status of Pending.
Viewing the response
Once you get a 271 response back, upload it against the original request (see uploading eligibility responses). The request row then shows the patient's coverage status, plan name, and whether they are eligible.
Example
Your agency has a scheduled inter-facility transfer next Tuesday for a patient with Medicaid. You want to confirm coverage before dispatching the ambulance. Go to Eligibility, click New Eligibility Request, fill in the patient's Medicaid information and next Tuesday's service date, then click Create Request. You send the downloaded 270 file to your clearinghouse, and when the 271 comes back, you upload it against the request to see the coverage details.