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Introduction: Patient's Eligibility provides information on patient’s Pharmacy
Benefit Insurance. It consists of the Payer Name, Patient information, Plan Name, Pharmacy type, Benefit Effective Date, etc.
Eligibility is fetched from the Pharmacy Benefit Managers (PBM) / Payer, which are generally the Insurance companies. In PrognoCIS,
the Eligibility request is sent to Surescripts which then sends it to the PBMs/Payers. Then the PBMs/Payers send an Eligibility response
consisting of all the details of the patient’s Insurance and Pharmacy to Surescripts, which in turns sends the response back to PrognoCIS.
Fetching of Eligibility in PrognoCIS depends on the value of the property rx.surescript.checkeligibilityatencstart.
If this property is On, then the Eligibility of the patient for Pharmacy Benefits is fetched on the start of encounter.
Requirements for the Eligibility to be fetched:
The Eligibility popup consists of Elibility Info table where all the PBMs/Payers are listed. The user is required to select any one applicable patient Eligibility by selecting the radio button associated with it. As soon as an Eligibility is selected, the Eligibility popup is closed. Following are the fields that are displayed for each Eligibility:
cancel button: Click on this button to exit the Eligibility popup without saving any changes done. retry button: If patient's Eligibility is not fetched and an error message is displayed, only then the retry button is displayed. The user needs to click on this button to send the Eligibility request again. |
See Also: | Prescription | Real Time Formulary and Prescription Benefit Information |