Description

Use to perform plan and pharmacy benefits eligibility.


Access


Through Main Menu

  • Click on the Patients button, in the Main Menu. 
  • Select a patient and then click on the More button, located in the toolbar. 
  • Then select the Eligibility option.

Through QuickLinks 

  • Click on the QuickLinks text, located at the top of the screen in Main Menu and select the Eligibility option.

Through Appointments 

  • Click on the Appointments button, located in Main Menu. 
  • Once in the Appointments screen, click on the More button, located at the top of screen.
  • Then select the Eligibility option. 


Sections


Buttons

  • History: View eligibility search history of selected patient. 
  • Refresh Services: Refresh the results grid when switching between Primary or Secondary plan .
  • Refresh Pharmacy: Refresh the pharmacy benefits checking.
  • Print: By pressing this button the eligibility will be printed.
  • Reset: Clear all entries to begin new search.
  • Previous: Returns to previous screen
  • Primary / Secondary: Select the plan to check for eligibility. 
  • Patient Information: Displays patient information, as stored in EHRez. (Displayed only for registered patients when accessing the screen from Patient Details, Appointments, Billing or Medication History).
    • Note: eligibility verification can be completed for any patient (registered or unregistered). Just select the plan, enter the contract and group number.

Tabs: 

  • Services: In this area, information related to the patient's health insurance eligibility, will be displayed. The tab will display the name of the insurer. Patient demographic information as it appears in the plan, either primary and/or secondary. It will also displays information on the details of the plan's benefits. You must select in the field at the top of the health plan name, the Primary Insurance or Secondary Insurance, in case the patient has a secondary plan. If there is no secondary plan, the field will be disabled. 

** For security, the information of cover number, group number, patient name, gender, etc. was hidden, since this example was made in a production environment **


  • Pharmacy: Displays pharmacy benefits checking result.

** For security, the information of cover number, group number, patient name, gender, etc. was hidden, since this example was made in a production environment **


  • Coverage Information: Displays the coverage information results. The last column displays the status.
  • All Pharmacy Coverage Types: Coverage details: Retail, Mail, Specialty or Long Term Care.
  • Subscriber Information: Subscriber demographics.
  • Note: Displays information relevant to the eligibility verification.



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