Check Eligibility in Partner

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.

Contents

1 Run the Eligibility Program
2 Eligibility Appointment List Screen
3 Patient Eligibility Screen
4 Sort Patients and Configure Display Settings

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

Press F1 to save your changes. If you are viewing the Patient Eligibility screen in checkin, you will continue to the next step in the checkin process.

F2, F3 – Scroll Backward, Forward

If the eligibility details extend below the screen, press F2 and F3 to scroll that portion of the screen.

F4 – Edit Policies

Press F4 to visit the patient’s policy screen, where you may review or edit their insurance policies.

F5 – Edit Patient

Press F5 to visit the Patient Editor (notjane). Press F7 from notjane to edit the account.

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.

Sort 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.

Display Settings

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.

Here are some related articles in Billing and Practice Management > Check Patient Insurance Eligibility:

CARC and RARC Values in PCC
When insurance carriers send payment and adjustment information, either on an EOB or an ERA, they often include a code with a small message. These codes are known as CARC values, or Claim Adjustment Reason Codes, and they are an industry-wide standard.
What is a Claim ID Number?
Every insurance claim in Partner has a unique identification number. The number appears in various Partner reports and programs, and you can use it to improve claim tracking and payment posting.
Submit Claims
Learn how to submit claims in PCC EHR or in the previous Practice Management tool.
Insurance Billing Overview
Partner's insurance billing tools help submit claims, review rejections, and work down your insurance accounts receivable. Partner helps you maximize the use of your time as you pursue proper insurance reimbursement.
Print Paper HCFA Claim Forms
While most claims are transmitted to payors electronically, sometimes you may need to generate a paper 1500 HCFA form.
The Claim Journey Explained
How is a claim created, and what happens in the background to make sure your practice is paid? Read below to learn some of the "under the hood" workings of claims after you post charges into PCC EHR.
Follow Up on Unpaid Claims and Insurance A/R
You can use PCC's tools to work on claims with errors, rejections, and denials. But what if a problem is fixed, but the claim wasn't resubmitted? Or what if an insurance payor simply never responds? Are some insurance payers regularly failing to pay you in a timely fashion? You may need specialized tools to track and work down your practice’s insurance A/R.
Check Patient Insurance Eligibility
PCC automatically checks insurance eligibility for all of a scheduled patient's active insurance plans, if the carriers support automated eligibility. You can use eligibility features in PCC to review and confirm eligibility for upcoming appointments. You can also review and re-check a patient's insurance eligibility status during Patient Check-In.
Review Policies in Practice Management and Add an Insurance Plan to Your System
This is a placeholder for the article excerpt, a one or two sentence summary.
Check Patient Insurance Eligibility
Learn how to verify patient insurance eligibility with PCC.
Submit Claims
Learn how to submit claims with PCC.
Work on Claim Errors and Rejections
After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
Insurance Billing (Advanced Training Session)
Watch this video to learn insurance billing workflows for configuration, claim review, and reporting.
Claim Error Reference
What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?