ELIGIBILITY MANAGEMENT Knowledge Center
HELP! | Revenue Cycle Management Support | 1.877.927.8000
Checking eligibility for a single patient WHAT’S IN YOUR PAYER LIST? Click the icon next to the Payer field to see a separate window containing the Payer List Legend.
GET THERE In Availity Central, click ELIGIBILITY. On the Eligibility Submission Management screen, click the Eligibility Management icon.
COMPLETE FIELDS
TIP: To change the Payer List default, on Availity Central click Administration, and then click Setup Payers.
1. Select a payer from the Payer list to display that payer’s required fields. 2. If available, select an option in the Search Type field. Note: The Search Type field does not display for all payers, and search type options vary.
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3. Complete the required fields marked with an asterisk.
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4. Click Next.
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5. View results in the rows below the search entry area.
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SAVE TIME •
Select a row with a result from a previous eligibility inquiry for that patient and click Clone Eligibility.
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For subscriber ID cards that have a magnetic stripe on the back, use a card reader to collect the patient data. Click Scan Card and then swipe the card through the reader. The information populates in the patient fields.
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ELIGIBILITY MANAGEMENT Knowledge Center
HELP! | Revenue Cycle Management Support | 1.877.927.8000
Using results VIEW STATUS Look in the Status column to help determine next steps for the eligibility. For help with understanding status information, use the Status Definition Help System in the Knowledge Center. For example, if the status for a result shows Need Info, click that row, and then click Fix to modify the entry fields. A
REVIEW ELIGIBILITY INFORMATION For eligibility inquiries, use the Quickview feature to view the details. These settings control the level of detail available if you use the Quickview feature. A. On Eligibility Management, click the Error/Info/Benefits Display icon to display the Eligibility Information window. Select and de-select check boxes to show errors, information, and benefit lines. B. Ask your office administrator to customize the quick view benefits for payers that you use the most. On Availity Central, click ADMINISTRATION and click Customize Eligibility Quickview Benefits.
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ELIGIBILITY MANAGEMENT Knowledge Center
HELP! | Revenue Cycle Management Support | 1.877.927.8000
Exploring toolbar Toolbar icons are activated depending on your available screen options and what you select on the screen.
ICON TEXT
ICON
DESCRIPTION/FUNCTION
Prev and Next
Click to navigate to different results screens. If the button is gray, you have reached the beginning or the end.
Refresh
Click to refresh screen data.
Error/Info/ Benefits Display
Click this icon to display a separate window that enables you to change the standard results view.
Filter by
In this field, select an option to filter the results by status. This also displays the number of results for that status in the list. Click a column header to sort a column in ascending or descending order. In the fields displayed below column headers, type your filter information, and then click Refresh or press the Enter key. The telephone icon indicates your office logged a support ticket for the result. The # icon indicates the format of the eligibility form. A 5 displays for 5010 and a 4 displays for 4010. The M icon indicates if a Member Liability Estimation can be calculated for a BCBSIL member Click to clear the column fields filter. Remember to click Refresh to refresh the screen with any results updates.
Back
Click the Back button to return to the previous screen.
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ELIGIBILITY MANAGEMENT Knowledge Center
HELP! | Revenue Cycle Management Support | 1.877.927.8000
Exploring toolbar, cont.
ICON TEXT
ICON
DESCRIPTION/FUNCTION
Clone Eligibility
Use to create an exact copy or “clone” of an existing eligibility which you can alter and submit for a different appointment date.
Transfer
Use this icon if you want to transfer a patient record from the current office to another office within the office hierarchy.
Process Claim Process UB Claim
Fix/Select Patient
For the selected patient, use this icon to manually enter a claim in the CMS-1500 format from the CMS 1500 tab or in the electronic format from the Advanced tab for professional claims. For the selected patient, use this icon to manually enter a claim in the UB-04 format from the UB04 tab or in the electronic format from the Advanced tab for institutional claims. Note: Additional amendment required for this process. Use this to correct problems encountered with the patient’s eligibility inquiry. For example, if the status for a row is listed as Eligibility not found, click Fix and re-enter the correction in the entry area. If Availity RCM detects a problem, the system updates the icon to Select Patient.
Retry
If a request times out, select the row and click Retry, to repeat a previously unsuccessful eligibility check.
Lock/Unlock
Since multiple users within your organization use the same results, use this icon to determine if the record is currently locked or unlocked; if locked, you can unlock, if needed.
Patient Report
Click to generate a report to view patient eligibility and benefits details.
Eligibility Mgmt Report
Click to create a PDF version of the report of all patients listed on the eligibility screen. You can print/save the information that displays on the screen.
Delete
Click to remove the selected eligibility record from the list of results.
Support Ticket
Click to submit a support ticket that contains applicable information about the record.
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