Intellect™
TROUBLESHOOTING
Eligibility
(04-19-2011)
Please be aware of the following issue:
For clinics using Real Time Elig via ENS where a patient whose 271 Eligibility was picked up but did not show in the Elig Tab under Schedule --►Appointment --►Full Day, it may be that the eligibility was placed under another family member's account. This may particularly be the case if an insurance uses the same subscriber number for the insured as well as other family members. If the eligibility does not show under another family member, contact PCS Support for additional help and/or information.
Also Note:
Eligibility responses vary from payer to payer. Some payer responses are very robust and include quite a bit of benefits information in addition to the eligibility response. Others are more limited in the information that they provide. If the information is not required in a 271 response, there is no way to make the payer send it. For example, Trizetto always returns all of the information to clinics that they receive from each payer. Please remember that this is just an Eligibility verification. This tells the provider if the patient is eligible for services on the date submitted.