Eligibility
Summary: To create an eligibility report, you need to go to your client's billing settings and add an insurer first. Then you can generate a report which will show you information from the payer in a PDF document.
To create an eligibility report, please navigate to your client's billing settings by going to Clients > [Client Name] > Billing > Settings. If you haven't yet added an insurer for this client, you will need to do that first.
Once the policy has been added, under Coverage Reports, click New to generate the report.
You will see a modal that contains options for what service codes you want to pass to the eligibility report generator. You may select up to 10 codes including codes for mental health and psychiatric services.
Note : Payer responses to eligibility requests do not always accurately represent benefits for mental health services. Consider calling the payer to get accurate coverage information.
When complete, you will see a link to the newly created report in the Coverage Reports section. The report will contain the information we receive from the payer formatted in a PDF.
Note : If eligibility requests are made and there is inaccurate or missing client information, the payer will not be able to deliver eligibility information. Please verify that you are not missing the client's DOB, that the member ID is accurate and that the NPI you are using is approved for eligibility requests with this payer. If we receive a failure response due to problems with the clearinghouse or the payer connection is down, we do not charge for the request. However, we do charge for requests made with inaccurate information.