Wiki Eligibility Verification

[jmnoah]

Does anyone have any good advice on the best way to set up auto-eligibility verification? Any examples of software applications that are really efficient? We are wanting to have an automated process that will generate a report for our persons served receiving Medicaid coverage. We are located in Iowa. Trying to avoid manually looking these up, as well as other types of insurance info, each month.

Thank you!
Jillian

 

[anabannasunshine]

Medicaid plan verification

When searching for an automated way to check Medicaid plans, you need to ensure the automated vendor will provide the Managed care information back to you which not all of them do. Since Iowa has expanded their Medicaid in 2016 to include managed care, automation of eligibility is only efficient if your chosen vendor receives the managed care plan information from Iowa Medicaid, including any differing member ID numbers if any one of your 3 contracted plans use numbers that are different than the Medicaid member ID#. I would start off with those questions first when researching the automated systems that work with your practice management system. I hope that helps!

 

[csperoni]

Most practice management systems will offer some type of automated eligibility verification (depending on carrier) either included or as an add on. I think almost any system that can do electronic claim submission should be able to offer this. Some carriers simply do not provide this information. For us, it's included in the practice management system and runs 3 days prior to the appointment. NY Medicaid (among others) do not provide eligibility in this format.