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Kareo Help Center

Encounter with Eligibility Info Enabled

Administrators have the option to enable eligibility status info on encounter forms. Eligibility info can be enabled on the Encounter Options screen using the checkboxes in the Eligibility Check section. Here is a description of the additional eligibility information available when that checkbox is enabled.

Encounter Screen with Eligibility Status

What Appears on the Encounter Screen?

As an additional safeguard, if you find patient eligibility was not checked before the appointment, you can check eligibility on the encounter before sending out the claim.

  1. View a patient’s primary and secondary insurance’s most recent eligibility information. The eligibility info is colored by status:
  • Insurance is active:  Message in green.
  • Insurance is inactive:  Message in red.
  • Eligibility could not be determined:  Message in orange.
  • Eligibility check never performed: Message in black.
  • Eligibility check is not supported in the PM: Message in black.
  • View report for status: Message in black. This displays when the report has multiple statuses and it's best to look at the full report to determine a patient's eligibility.
  1. Hover over the insurance name to see the policy number.
  2. Check Eligibility and View Report link appear next to each patient insurance. The Check Eligibility link will use the Date of Service in the "From Date" field. 
  3. If a policy is no longer valid or should not be billed, the policy can be deactivated. Inactivate an insurance policy by clicking “Active” beneath the policy name to clear the checkbox, then save the encounter.
    • As best practice, check outstanding claims before inactivating an insurance.

What If Your Encounter Screen Has a Custom Layout?

No problem. If your practice is using a custom encounter view, simply restore the encounter view to see the new eligibility features, and apply your customizations once more.

Right click on the encounter screen and select Customize Layout. Then click Restore. Next, apply customizations by dragging and dropping fields and click Save.

View All Encounters or Claims with Eligibility Issues

Billers will benefit from a single view to track and process encounters and claims with eligibility issues. Find the eligibility issues easily in order to fix them and get paid sooner. 

Once an encounter is saved with an eligibility issue, it is automatically flagged with an orange icon and can be tracked on the Find Encounter screen using the flag.

You can filter by Issue Type and look for Eligibility in the search field to view a list of all encounters with eligibility issues. This functionality is also available on the Find Claims screen. 

The practice dashboard will alerts you of eligibility issues related to encounters and claims on the To Do List.

 

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