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Kareo Help Center

Check Patient Eligibility

Watch a demonstration of the features covered in this article in our Check Patient Eligibility video.

Real-time insurance eligibility checks enable the practice to confirm a patient has valid insurance coverage prior to their appointment. Patient eligibility can be checked from the AgendaCalendarPatient Appointment window, or a patient's insurance policy information.

Important notes regarding eligibility checks:

  • Best practice is to check eligibility 1–3 days before the patient appointment.
  • A patient's insurance must be connected to the system by the Kareo Success Team before eligibility can be checked.
  • Not all insurance companies support eligibility checks. Contact the insurance company's eligibility department to confirm whether patient eligibility requests are supported. 

Check Patient Eligibility

From the Agenda

  1. Hover over the Platform icon in the upper left of the window and select Agenda. The Agenda opens.
  2. Click Run Eligibility Check for All to check insurance eligibility for all patients scheduled that day. 
  3. Click on a patient appointment and click Run Eligibility Check to check eligibility for an individual patient.

 

KMB check eligibility from agenda.png

From the Calendar 

  1. Hover over the Platform icon in the upper left of the window and select Calendar. The Calendar opens.
  2. Click Run Eligibility Check for All to check insurance eligibility for all patients scheduled for the current day. 

KMB check eligibility from calendar convergence.png

From the New Appointment Window

  1. Open a new patient appointment.
  2. Click Run Eligibility Check

PF run eligibility check from new appointment.png

From the Patient's Insurance Policy Info.

  1. Add or view a patient's insurance policy information.
  2. Click Run Eligibility Check

KMB check eligibility from insurance.png

Eligibility Icons and Status Messages

Once an eligibility check has been performed, a status message shows if the patient is covered and how recently eligibility was checked. You also have the option to run the eligibility check again or view the eligibility report.

Eligibility Verified

Verified patient eligibility displays in green.

  1. A green icon displays in the patient's appointment on the Agenda and Calendar. Hover over the icon to view when eligibility was last verified.
  2. A green verification message displays in the patient appointment details on the Agenda.

KMB eligibility verified2.png

Eligibility Could Not be Determined

Insurance eligibility that cannot be determined shows in orange. 

  1. An orange icon displays in the patient's appointment on the Agenda and Calendar. Hover over the icon to view eligibility details.
  2. An orange "Eligibility could not be determined" message displays in the patient appointment details on the Agenda.

 

KMB eligibility could not be determined2.png

Patient Not Covered

Insurance coverage that is no longer valid displays in red.

  1. A red icon displays in the patient's appointment on the Agenda and Calendar. Hover over the icon to view when coverage ended.
  2. A red "Patient not covered as of (date)" message displays in the patient appointment details on the Agenda

 

KMB eligibility patient not covered2.png

Eligibility Troubleshooting

If eligibility could not be determined, check for the following errors:

  • Incomplete or denied EDI payer enrollment
  • Incorrect Group or Individual NPI setup
  • Incorrect Electronic Payer Connection setup
  • Incorrect member information provided

If a patient's insurance coverage is no longer valid, or if eligibility could not be determined, follow these steps for resolution:

  1. Contact the patient to verify the insurance information.
  2. Review the insurance information you receive from the patient against the information in Kareo.
  3. Update any errors in the insurance information in Kareo and run a new eligibility check.
  4. If the patient's insurance information is accurate and coverage is no longer valid or eligibility cannot be determined, discuss any costs with the patient that will be incurred for the visit.