Topics Run Eligibility for Unbilled Claims (INS_ELIGIBILITY_4UNBILLCLAIMS) Search:  
Introduction: The scheduled process Run Eligibility for Unbilled Claims (INS_ELIGIBILITY_4UNBILLCLAIMS) is introduced on the Billing Scheduled Process Master screen to fetch eligibility as per the Date of Service (DOS) of unbilled claims. This scheduled process runs based on the insurances selected on the claim for the respective DOS.

Following are the parameters to configure this scheduled process:
  • Run Eligibility for Claims dropdown: This dropdown displays 4 options: Entered, On Hold, Ready To Send and All. If any of the first 3 options are selected, then the scheduled process considers only those unbilled claims that are in the selected status. If All is selected, then the scheduled process considers unbilled claims in all three statuses. The default value of this dropdown is All.
    Note: Claims in Billed status are not considered in this scheduled process.


  • Eligibility Last Ran X days ago: Enter the number of days after which this scheduled process should be executed as per requirement. The default value of this field is 7. If 0 is entered in this field or this field is left blank, then the system defaults it back to 7 on click of the OK button.


  • Insurance dropdown: This dropdown displays two options: All and Primary. If All is selected, then the scheduled process considers both Primary and Secondary insurances associated with the claim. If Primary is selected, then the scheduled process considers only the Primary insurance associated with the claim.


  • Claim Filing Code: Displays the claim filing code of the Insurance associated with the claim. Click on the Search icon next to the text field and select a claim filing code from the Claim Filing Code popup. The selection in this field can be cleared by clicking on the Clear hyperlink.
After the schedule process is executed based on the selected criteria parameters, the output of the eligibility results is reflected on the Eligibility popup accessible by clicking on the Eligibility button on the Patient Insurance popup for unbilled claims. The user can navigate to the Eligibility popup for the individual claim to view the eligibility details.

Note:
  • This scheduled process is applicable to all Clearing Houses that support real time eligibility.
  • This scheduled process also considers claims for which the associated insurance is marked as Inactive from Insurance Master.
  • This scheduled process does not consider eligibility is fetched from Patient Registration or Patient Account screens.
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