Adding Verifications
Creating a New Verification
Manual Status Update
Record results of an eligibility check performed outside the system:
- Select the date the check was performed
- Choose the appropriate status (
Eligible,Not Eligible)
This option is useful when eligibility is verified through other means (phone call, payer portal, etc.) and the result needs to be recorded in the system.
Real-Time Check
This triggers an automated request to the payer via the clearinghouse.
Requirements:
- Enrollment: For payers requiring enrollment, a completed enrollment must exist with an NPI that matches the business’ NPI.
- Funds: The business must have a sufficient balance, as real-time checks incur a small processing fee.
Validation
If the Plan Number and Group Number are set on the Payer, the values are compared with the response. If they do not match, the status is marked Not Eligible.
Automatic Update
Upon a successful check, the client’s Insurance record is updated with the returned Plan/Group numbers and Coverage Start/End dates.
Verification Statuses
- 🟢 Eligible: Coverage is confirmed active for the requested date.
- 🟡 Ineligible: Coverage is expired, inactive, or specific details (Plan/Group) did not match.
- 🔴 Error: An issue occurred during communication with the payer. Click View Details to see the raw JSON response and error message.
