Enhanced Eligibility Verification
The same eligibility request, sent to the right payer.
An eligibility check asks a payer whether a patient's known policy is active. When the request goes to the wrong payer it comes back not found, and lands in a queue where a person spends the next several minutes finding the right payer and sending it again.
An eligibility check: the payer name and address are resolved to the right payer ID, coverage is confirmed active, and the funding type is identified as self-funded.
What goes in and what comes back
Send eligibility requests exactly as you do today. Every request needs a payer ID, the code that tells the network which payer to ask. Integrex Health resolves the payer name and address on the account to the correct payer ID before the request goes out.
Coverage comes back confirmed active, with funding type identified in the same response. Fewer requests come back not found. Nothing about your provider identifiers (NPIs) or your payer enrollment changes.
Why does a valid request come back not found?
Send a valid request to the wrong payer ID and the payer answers truthfully: it has never heard of the patient. Multiply that across a month of registrations and it becomes rework nobody budgeted for.
A standard eligibility response also says nothing about who funds the plan. With that in the answer, the authorization or appeal that follows starts from the right rules.
What changes for you
Fewer requests come back not found, so less of the day goes to rework. In the Orchestration Layer this is Verify for accounts that already show a payer, with Classify answered in the same response.
Send us a week of eligibility requests.
We will show you how many came back not found while the coverage was active.
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