Eligibility Verification
Once enrolled for B2B Eligibility Verification through the MacPractice Enrollment Department, a username and password will be assigned from Change Healthcare. A MacPractice EDI Support Representative will assist in getting this information entered into the software. This information is located in the eClaims ability under Template Values on your ProxyMed template.
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To submit eligibility checks, a default eClaims template must be set under References > Offices > Default Template. The MacPractice EDI Department can assist with getting this entered correctly.
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Next, add the correct Change Heatlhcare Payer IDs entered for any insurance companies that an eligibility check will be run. A list of participating insurance carriers can be found on Change Healthcare’s Real Time Payer List from the URL below.
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These Payer IDs can be placed under References > Insurance Companies in the Claims Payer ID field and/or Eligibility Payer ID field.
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If nothing is entered in the Eligibility Payer ID field, the system will look at the Claims Payer ID field. |
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Note: If there is a plan set on the insurance reference, there are also fields for ‘Claims Payer ID’ and ‘Eligibility Payer ID’ under References > Insurance Companies > Plans > Demographic. |
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Next, the patient account will need to be checked for completion of required fields. Under the Patient tab of the Patients ability, the following fields must be set for a successful eligibility check:
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Default Office
Default Provider
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Each patient will need to have his or her insurance set here. Correct the patient information in this window:
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First and Last name
Address
Sex
Social Security Number (SSN)*
Date of Birth*
Subscriber ID
Group Number (if applicable)*
*This item may or may not be required, depending on the payer.
From here, select the patient's insurance to be checked and click the ‘Check Eligibility’ button.
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From the popover shown below, select the specialty type/type of service and click the ‘Submit/Next' button. Specialty type ‘Health Benefit Plan Coverage’ will return generic benefit coverage information. To quickly move to this option, press ‘H’ on the keyboard.
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Note: Some payers do not offer eligibility for specialties or certain specialties, in which case they would return generic benefit coverage despite your specialty selection. |
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If checking eligibility for a Non-Medicare insurance carrier (based on insurance payer plan type under References>Insurance Companies>Claims), results page will display for the eligibility check after hitting the Submit button.
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If checking eligibility for a Medicare carrier, a popover page for preventative care codes will be presented. Select from the list of Preventive Service (HETS Requirement for Medicare/CMS) procedure codes in order to run the check specific to those codes. The results will then contain details specific to the selected procedures.
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