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Kareo Help Center

Navigate Rx Eligibility

Updated: 10/21/2021
Views: 1213

The Rx Eligibility tab in a patient's record shows the patient's medication coverage.

An Rx eligibility check will run for a patient when a provider with an NPI prescribes a medication, performs a medication history check, or visit the Rx Eligibility tab in a patient's account. The information is pulled from Surescripts using the patient's name, date of birth, address, and gender.

Available for Kareo Clinical subscribers.

Access Patient Account

  1. Enter the first 2–3 letters of the patient's name or date of birth (mm/dd/yyyy) in the top navigation bar search box.
  2. Click to select the patient from the auto-populated results. The patient's Facesheet page opens.
  3. Click Account. The Account page opens.
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Navigate Rx Eligibility

  1. Click the Rx Eligibility tab. The Rx Eligibility page opens.
  2. Navigate Rx Eligibility:
    1. Status: Displays if the coverage is Active or Inactive.
    2. Plan Name: Medication coverage plan name
    3. Rx PCN: Associated plan number.
    4. Pharmacy Benefit Manager (PMB):  Administers the prescription program for the plan.
    5. Last Checked: Date of the last eligibility check.
    6. Pharmacy Coverage: Displays the plan coverage for Retail, Mail Order, Specialty, and Long Term Care.
    7. Mismatched Demographic Info: Error messages will display if there is a discrepancy in the patient information.
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