You can review and confirm patient insurance eligibility in either PCC EHR or in the Partner practice management system.
For information on how to review and confirm eligibility in PCC EHR, read Patient Insurance Eligibility with PCC.
Read below to learn how to check Eligibility in the Partner Practice Management System.
Run the Eligibility Program
The Eligibility (elig) program in Partner displays patient insurance eligibility. You can use the program to view a list of appointments and their accompanying eligibility information, request an eligibility update, or make notes or set a status about eligibility. While using the program, you can also contact the patient’s family and update insurance information.
You can run Eligibility from the Daily Operations window or by typing elig at a command prompt.
If you would like to add the Eligibility program to your Daily Operations window, contact a PCC Software Support technician at 800-722-1082.
Eligibility Appointment List Screen
The main screen of the Eligibility program displays patient appointments along with a summary of insurance policy and eligibility information.
From this screen you can review basic eligibility for all of a patient’s active plans. If they have more than one active plans, both will be listed.
Dates: Today’s appointments appear by default. Press the right or left arrow keys to choose a different day or enter any date in the date field.
For each line, you can review:
Time: Appointment Time
Patient: Patient Name
Ins Group: Patient’s primary policy insurance group
Elig Response: The date of the last successful eligibility verification for this appointment
I/A: The eligibility response from the carrier, either Inactive, Active, or blank (unknown)
Elig Status: User-entered eligibility status
Verified: User-entered date indicating when eligibility was reviewed and verified
Select an appointment with the arrow keys and press F1 – Select Patient to view eligibility details.
Patient Eligibility Screen
Choose any appointment on the Eligibility Appointment List and press F1 – Select Patient to view the Patient Eligibility screen.
The top section of the screen displays patient information, including the patient name, the primary care physician, the subscriber name, and the appointment information. Primary insurance information appears as well.
The middle of the screen includes fields in which the user can set a status, mark the date they verified eligibility, and enter notes.
The bottom half of the screen displays the results of the most recent eligibility confirmation. Partner takes the details sent by the insurance carrier and summarizes them. If no report appears, press F6 – Request Elig to request one from the carrier. You can press F7 – See Full Report to review the carrier’s complete report.
F1 – Save, Next Step
F2, F3 – Scroll Backward, Forward
F4 – Edit Policies
F5 – Edit Patient
F6 – Request Elig
Press F6 to check eligibility. If the patient’s primary insurance allows automatic eligibility requests, Partner will perform a new eligibility check and update the eligibility information on the screen.
F7 – See Full Report
The screen includes a summary of the carrier’s eligibility report. To view the report, press F7.
F8 – Next Policy
If a patient has more than one active insurance plan, press F8 to shift down their list of policies and review eligibility reports for each.
Sort Patients and Configure Display Settings
There are two configuration tools in the Eligibility program. You may sort the list of appointments, and you may set a filter so only certain appointments appear.
Note: Changes to the settings in Eligibility will affect only the user who makes the changes. Other users at your practice may have their own sorting rules or display settings.
Press F4 – Sort Settings on the Eligibility Appointment List screen to view the Sort Settings screen.
You can enter two different sort criteria for the appointment list, altering the first and second column by which the screen will sort appointments.
The default entries are Appointment Time and Inactive/Active Status. You can use an asterisk (*) to view and select an alternative sort value.
Press F5 – Display Settings on the Eligibility Appointment List screen to view the Display Settings screen.
Use the checkboxes on the top of the screen to show or hide Active, Inactive or Unknown eligibility and/or specific user-entered statuses.
Press F4 – Select Ins or F5 – Select Loc to alter which insurance groups or locations will appear on the appointment list.