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This article presumes that you have set up your Entities Table and completed enrollments with your payers as described in the Inovalon Payer Enrollment Guide. If you haven’t already, we strongly recommend that you review the process in the Payer Enrollment Guide and complete that, as it will be necessary when making Eligibility Requests. |
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Please be aware that there is a price per eligibility check of $0.20 as of the time of this writing (08-28-2024). This cost may change in the future, so be aware that there is a price per eligibility check. |
Checking Eligibility
There are two methods for checking Eligibility.
First Method - Making an Eligibility
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Request
On the front landing page when you log into Inovalon’s portal, you can create Eligibility requests by navigating to the “Front-end RCM” tab. This method will leave a history of these eligibility checks which you can refer back to as necessary.
When you click it, you’ll see a list of options under “Eligibility Workflow”. Click on “Make an Eligibility Request.”
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First, you’ll select your NPI from the available ones listed, as shown in the image below. Please note that if your NPI is not present, you can click the “Add or Edit NPIs” link in the lower right corner of the NPI selector to make changes if this is necessary.
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Selecting the Payer
Once you’ve selected the NPI, you’ll be brought to the Payer selection area:
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Of importance, however, is the “Send each Service Type Code in a separate transaction” checkbox here. If this is checked, each service type code will be included in a separate transaction, as opposed to one transaction with multiple service type codes. This means if you have 5 Service Type Codes selected with that checkbox checked, 5 transactions would be sent from the payer.
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Entering Patient Details
Once you’ve selected the payer, you’ll then be taken to Patient Details. Each payer can have different criteria for what information will be needed in here and different restrictions for service date selections, so this can look very different depending on which payer you’ve selected.
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Once you’ve added all your patients, you can click the Submit button to send this Eligibility Request.
Second Method - Checking Eligibility in CMP
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Tracking Eligibility Requests
You can find your existing Eligibility Requests that were created by the First Method described above under the “My Dashboard” link under the “Front-end RCM” selection. You can also find your history of Eligibility Requests in the same place under “Eligibility Request History”.
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