The majority of rejected eligibility responses you'll encounter in the Clean-Up page will be missing or invalid information. This means that some part of the information entered does not match the information the payer has in their online eligibility system.
Typically, the response will tell you exactly what is missing. If you get stuck, here are some tips for getting your patient to risk free:
Ensure all information requested has been entered. It is especially easy to miss the Subscriber information at the bottom of the window. Without this information, eligibility may not run properly for the patient.
Enter the information exactly as it appears on the patient's insurance card. Some insurances are very picky when it comes to verifying information. For example, if the patient John Smith is listed as John Smith II on his insurance card, ensure this information is entered with the "II" portion in the Last Name field.
Ensure that the member ID has been entered with the correct characters. Sometimes, the difference between an O and a 0 can mean a risk free response and guaranteed payment for you!
Verify which payer should be selected by referencing the payer listed for "Send medical claims to..." on the insurance card. This will make sure the patient is being verified through the correct eligibility system.
Correcting Missing or Invalid Information
For Integrated Partners
Go into your EHR and edit the patient information that is invalid or missing.
Your EHR is the source of truth. That is why we ask that, when possible, you always make edits and updates there.
For Non- Integrated Partners
Click on the desired patient
Click "Patient Information".
Click "Edit" at the top right of the screen
Make the necessary changes to the entered information
Click the "Save" button at the bottom of the screen