Checking a Patients eligibility is one of the most crucial steps to onboarding a Patient. The reason being, we never really know what is going on with a Patient and their insurance, financial liability without checking. Tip of info: Sometimes we still don’t know based on the check…

 

📚Resources Needed

🚀 Tips & Tricks

  • A lot of the insurance information needed can be found on the insurance card. 
     
  • Depending upon where the Patient booked the appointment will determine where you can get the Patient and insurance information. 
     
  • If something with the insurance doesn’t make sense, call the Patient to confirm.
     
  • Be sure to watch this demo on how to perform an eligibility check in Availity. 
     
  • Here are the main actions your doing: 
    1. Searching insurance eligibility
    2. Updating Patient demographics
    3. Addressing any possible hiccups

       

📘 Instructions

Make sure not to forget one of these steps. 

  1. First you will gather the Patients insurance information from wherever they booked the appointment from.  
     
  2. Login to Availity. 
     
  3.  From the homepage, click on Patient registration > Eligibility and Benefits
     


 

  1. In the Payor section, be sure to select Humana



     
  2. Select the Provider the appointment is for. 



     
  3. In Patient Information, enter in the Patient Aetna Member ID and DOB

  4. In Service Information, type in 30 (Health benefit coverage) and click search.
  5. Always make sure they have Active coverage. 

     
  6. Check what their Deductible may be. In this specific example there is not one. And It makes sense because this is part of the Medicare plan. 



     
  7. Scroll down to Benefit Information (Professional Physician Visit - Office) and look to see what the Copay may be for the Patients visit. In this specific example, you will see that the Copay is $0 because this Patient is not seeing a Specialist. 



     
  8. Now that you have the Patient insurance eligibility, enter the information into the Patient demographics section of the EHR.



     

Here is a video to help you out. 

https://drive.google.com/file/d/16gkFqXXtksUBNbGNZBsYB2bZ4xzkGIxu/view?usp=drive_link