Real-time patient eligibility checks can be done directly from Kareo for hundreds of the nation's largest government and commercial insurance payers. This enables you to confirm that patients have valid insurance coverage before scheduling the patient's visit, reducing downstream claim denials and uncollectible accounts receivable. You can also run daily batch eligibility checks. If you are checking eligibility for the first time, read the Patient Eligibility Setup section first.
Kareo submits a real-time request with the payer's system and returns an eligibility report that can be printed or saved to the insurance policy record for the patient. You can check patient eligibility from three workflows: The patient record, the patient insurance plan, or a patient appointment.
To check patient eligibility
- Open one of the following:
- Click Check Eligibility at the bottom. This displays the Check Patient Eligibility window.
- Enter the information.
- Patient: The patient's name is automatically entered from the record.
- Case: By default the primary case is automatically entered. If different, select the case from the drop-down menu.
- Policy: By default, the policy related to the case is automatically entered. If checking for a secondary insurance policy associated with the case, select the policy from the drop-down menu.
- Provider: Select the provider for whom you want to make the request.
- Service Type: Select a service type for certain payers from the drop-down menu. If no service types are allowed, you will only see the option "30 - Health Benefit Plan Coverage" which is the default for all payers.
- Once you've entered the information, click Check Eligibility Now. The system will show a "working" icon until the report is ready:
Note: For many payers, eligibility verification requests may be unavailable between the hours of 11:00pm and 6:00am EST on weekdays, and throughout the day on Saturdays and Sundays.
- The information contained in an eligibility report will vary depending on the insurance payer. Some insurance payers provide detailed information; such as the status of the insurance policy (active or inactive), the type of coverage the patient has, any patient copays or deductibles due, etc. Other insurance payers simply report if a patient’s insurance status is active or inactive.
- If the verification request is rejected, it will be noted in red. It may simply be that certain information provided to the insurance payer related to the patient or the patient’s insurance policy did not match up to the insurance payer’s system. Review the patient record and policy information, make changes and resubmit, or call the insurance payer for verification.
- When finished, select one of the following options:
- Click Print to print the report.
- Click Save to save the report. The report is saved under the Eligibility tab of the patient's insurance policy.
- Click Save & New to save the report and perform another verification.
- Click Cancel to exit out of the window.
Patients Not Eligible or Not Covered
If a patient's insurance coverage is no longer valid or if eligibility cannot be determined, follow these steps for resolution:
- Contact the patient to verify the insurance information.
- Review the insurance information you receive from the patient against the information in Kareo.
- Update any errors in the insurance information in Kareo and run a new eligibility check.
- 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.