Online Eligibility Check (OEC)

 

An online eligibility check lets you check the eligibility of a patient with the Department of Human Services or private health insurers, and to estimate out-of-pocket expenses for in-hospital care. The patient can then provide informed financial consent.

Before you can conduct an online eligibility check on an estimate, you must first create the estimate.

 

1.      Within the patient's record, select the Estimates menu item. In the example below, we have created an estimate for an In-Hospital Claim, and we will conduct an OEC for this estimate.

2.      Within the list of Estimates, select the estimate you wish to perform an OEC for.

3.      Click  The Online Eligibility Checking window appears, as shown below.

o       Complete the form as desired, ensuring to provide data for any field marked with *. Upon attempting to submit the form, you will be prompted to provide any required information you have missed.

o       The Service section at the bottom of the window (Service Date, Service Quantity, Service Rate etc) displays settings for any selected service item. For example, we have selected item 30071 in order to access the settings for it, and we are modifying the AfterCare Override Indicator for the service item.

o       Ensure you have received patient consent to submit the online check by ticking the associated check box at bottom-left of the window.

 

 

4.      When you are ready to proceed with the check, click  The online check commences.

 

5.      After submitting the eligibility check processing, you will be returned to the Estimates window.

o       Notice in the example below that the estimate is now assigned an OEC ClaimID.

o       The status of the check is displayed. In our example, the claim's status is Awaiting Process Report.

o       Estimates with a claim status of "Process Report Received" can be printed via the button.

o       The check typically takes up to 20 minutes, but may take longer.