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Tebra Help Center

Check Patient Insurance Eligibility

Updated: 06/23/2023|Views: 16102

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 DashboardCalendar, Appointment page, or a patient's insurance policy information.

Important notes:

  • Best practice is to check eligibility 1–3 days before the patient appointment.
  • Available for Billing subscribers.
  • A copy of the report is saved in the Desktop Application under the patient's case on the Eligibility tab of the insurance policy.
  • Not all insurance companies support eligibility checks. Contact the insurance company's eligibility department to confirm whether patient eligibility requests are supported.

Check Eligibility for All Patients

Eligibility can be checked for all patients scheduled for a specific day through the Dashboard or the Calendar.

From the Dashboard

  1. Hover over the Platform icon and click on Dashboard. The Dashboard page opens.
  2. Click Check Eligibility for All. An eligibility icon and status displays under the patient's appointment.

From the Calendar

  1. Hover over the Platform icon and click on Calendar. The Calendar page opens. 
  2. Click Run Eligibility Check for All. An eligibility icon displays on the appointment.

Check Patient's Eligibility

Patient specific eligibility can be checked through the Appointment Card or the Appointment.

  1. Hover over the Platform icon and click on Dashboard. The Dashboard page opens.
  2. Click on the patient's appointment to view the Appointment Card.
  3. Click the more options icon and select Check Eligibility. The eligibility field updates with the patient's eligibility status.

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.

  1. Eligibility Verified: Verified patient eligibility displays with a green icon and the date eligibility was checked.
  2. Eligibility Not Determined: Insurance eligibility that cannot be determined displays with an orange icon and the date eligibility was checked. 
  3. Not Eligible: Insurance coverage that is no longer valid displays with a red icon and the date eligibility was checked.

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 Tebra.
  3. Update any errors in the insurance information in Tebra 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.