Patient Eligibility
If the practice has subscribed to the Max or Complete plan, you can perform real-time patient eligibility checks for hundreds of the nation's largest government and commercial insurance payers directly from within Kareo. Using Kareo's real-time patient eligibility engine empowers you to make sure patients have valid insurance coverage before scheduling the patient's visit, which helps reduce downstream claim denials and uncollectible accounts receivable.
There are two ways to do this. First, you can select the Check Patient Eligibility item from the Patients menu. This will display a task allowing you to select the patient, case, and insurance policy, and then request a patient eligibility report. Kareo submits a real-time request with the payer's system and returns an eligibility report that can be printed or saved to the insurance policy record for the patient. Second, you can access this function at the same time you are entering a new insurance policy for a patient.
Note: There are a few steps that an application administrator must take to set up a practice before users are able to perform eligibility verification. Please refer to the feature guide, Real-Time Patient Eligibility. (www.Kareo.com/help).
The below instructions explain how to check patient eligibility once the system has been configured to support eligibility verification.
1. On the Patients menu, click Check Patient Eligibility. This displays the Check Patient Eligibility task.
2. Enter the following information:
Patient: Enter the patient's name or ID. Optionally, you can click the patient selector button to open the Find Patient task (or browser) and then use the search feature to locate the patient (for help in locating a patient record, see Find Patient). Once you locate the patient, double-click on the patient record to select it.
Case: Once the patient is selected, the system automatically populates the Case field with the primary case recorded on the patient record. If you are checking insurance eligibility for a different case associated with the patient record, select the correct case from the drop-down list.
Policy: Once the case is selected, the system automatically populates the policy field with the primary insurance policy recorded on the patient record for the case selected. If you are checking insurance eligibility for a secondary insurance policy associated with the case, select the policy from the drop-down list.
Check Eligibility Now: Once the patient, case, and policy have been selected, click the Check Eligibility Now button.
3. The system will initiate an eligibility request; and until it receives a response, the system will show a "working icon" and display a message that reads "Checking Eligibility."
Once the response is received, the eligibility report will be automatically displayed on screen. The information contained in an eligibility report will differ slightly, depending on the insurance payer. Some insurance payers provide very detailed information; such as the status of the insurance policy (active or inactive), the type of coverage the patient has, any patient copays or deductibles due by the patient, etc. Other insurance payers may simply report if a patient’s insurance status is active or inactive.
If the verification request has been rejected, it will be noted in red within the eligibility report. It may simply be that certain information provided to the insurance payer related to the patient or the patient’s insurance policy does not match up to the insurance payer’s system. You will need to review the patient record and the patient’s policy information and resubmit or call the insurance payer for verification.
4. After reviewing the eligibility report, you can do one of the following:
Print the report by clicking the Print button on the bottom of the report.
Save the report to the patient’s insurance policy record, by clicking the Save button.
Save the report and perform another verification check by clicking the Save & New button.
Cancel from the screen without doing any of the above by clicking the Cancel button.
As previously mentioned, you can also perform patient eligibility verification at the same time you enter a new insurance policy for a patient. Simply click the Check Eligibility button on the Task Button Bar of the patient's insurance policy record to open the Check Patient Eligibility task.
Note: It is normal to not receive a response from payers for eligibility verification requests between the hours of 11pm and 6am EST on weekdays, and throughout the day on Saturdays and Sundays.
Still need help? Contact support here.