Check a client's eligibility when they join
Check a client's policy when it's added so you can fix any problems before their session.
- The client has a policy on file with the member ID, along with the client's and policyholder's names and dates of birth
- You've connected an electronic payer, and your practice is credentialed and enrolled with that payer (Lesson 4.5)
Read the eligibility result
If the client added their insurance through your intake form, you don't need to start the check yourself. Carepatron creates the policy from their answers and sends the eligibility request for you, at no cost. When the result comes back, the policy shows a Verified tag.
Go to Clients → select the client → Insurance tab. Then check that:
- The coverage is active.
- The details match the card, including the member ID, group, plan, and dates.
That's all you need to check. If you'd like more detail, click View report to see the co-pay, coinsurance, and deductible.
Run another check when you need one
Run the check yourself if you added the policy by hand, or if the client changes insurer or renews their policy.
- Go to Clients → select the client → Insurance tab.
- Make sure the policy includes the member ID, along with the client's and policyholder's names and dates of birth.
- Hover over the policy → Eligibility request → choose the benefit codes → Check eligibility.
You can also check from the appointment. Open it in the Calendar, go to the Billing tab, then click Check eligibility in the Insurance section. If the check fails, make sure both profiles are complete and your billing profile matches the details enrolled with the payer. Then try again with one benefit code.
During the free trial, Eligibility request doesn't appear. Checks switch on once you're on a paid plan.
Check whether you need prior authorisation
Some payers need to approve certain services before the session. If an eligibility check shows Authorization required for a service, ask the payer for an authorisation number before the session.
When you create the claim, enter that number in Prior authorization number (box 23) under Miscellaneous information. Carepatron doesn't fill it in for you, and a payer that needs it will deny the claim without it (Lesson 6.6).
To keep track of which clients need authorisation, you can create your own client tag, such as "Auth required".
Tick these off in your own workspace before moving on.
How much does an eligibility check cost?
Each check you run costs 15c, and you pay as you go. Checks that run automatically from your intake form are free.
How often should I check eligibility?
Check once when the client joins, then check again if they change insurer or renew their policy. There isn't a firm rule beyond that, although some practices check again at the start of each new episode of care.
What do I need before I can run a check?
You'll need a paid plan (checks are switched off during the free trial) and an electronic payer, because manually added payers aren't supported. Your practice also needs to be credentialed and enrolled with that payer, and the client needs a policy on file.
Does Verified mean the claim will be paid?
No. Verified confirms that the coverage is active and the details are correct. The claim still needs the right codes, a signed note, and prior authorisation if the payer requires it.
What can I do with insurance during the free trial?
You can add policies and payers, record insurance payments, and create claims and CMS-1500 forms. Eligibility checks and electronic claims are switched off until you're on a paid plan.