Checking a Patient's Insurance Eligibility

1. Accessing the Patient’s Registration Page

1. Log In to Your Account:
   • Sign in to your iClinic account using your credentials.
2. Navigate to the Registration Section:
   • Click on the Register icon from the dashboard.
3. Search for an Existing Patient:
   • In the window that appears: 
     • Select “Look Up Existing Patient” on the left side.

Enter the patient’s: 

• Last Name
• First Name
• Date of Birth
• Click “Go” to search.
• Retrieve the Patient’s Record:
• From the search results, select the correct patient.
• Click “Retrieve” to access the patient’s registration page.

2. Performing an Online Eligibility Check

1. Open the Eligibility Section:
   • On the patient’s registration page, click the “Create New Office Visit/Eligibility” tab.
2. Initiate the Eligibility Check:
   • Locate the “Online Eligibility Check” section in the middle of the screen.
   • Click the “Send Request” button.
3. Confirm the Request:
   • A confirmation box will appear asking if you’re sure you want to request online eligibility.
   • Click “OK” to proceed.
4. Review the Eligibility Status:
   • The system will process the request and return one of the following statuses: 
     • Finished (Light Blue): Eligibility was successfully verified. Click the patient’s name to view detailed coverage information on the right side.
     • Rejected (Pink/Red): The request was denied. Click the patient’s name to view the rejection reason on the right side.
     • Created (White): No response was received from the insurance company, meaning eligibility information isn’t currently available.

3. Troubleshooting Eligibility Issues

A. Confirming Insurance Supports Online Eligibility

1. Check for Online Eligibility Availability: 
   • Go to the patient’s insurance tab.
   • Look for the message “Online Eligibility Checking Available” (displayed in green).
   • If the message isn’t visible, there may be two possible issues: 
     • The MRT ID is missing.
     • The patient has no attending physician listed.

B. Adding the MRT ID

1. Access Insurance Settings:
   • Click on the Settings icon from the dashboard.
   • Select General, then click on Insurance.
2. Locate the Insurance Company:
   • Scroll through the insurance list and click on the insurance company in question.
3. Enter the MRT ID:
   • In the Edit Insurance box, scroll down to the Billing Information section.
   • Locate the MRT ID field and enter the appropriate MRT ID.
   • Click “Save” to apply changes.
4. Finding the MRT ID (If Unknown):
   • Visit the designated payer website (URL provided within iClinic).
   • Click on the “Payer Name” tab.
   • Enter the name of the insurance company and press Enter.
   • From the search results, select the insurance company that matches. 
     • Note: Some insurers may have multiple MRT IDs. Any listed MRT ID should work.
   • Check the “Enroll” column: 
     • N (No Enrollment Required): You can proceed without additional steps.
     • Y (Enrollment Required): Additional setup with the insurer may be needed.

C. Correcting ZIP Code Issues

1. Error Message: ZIP Extension Cannot Be Empty
   • If you receive this error: 
     • Enter the ZIP code extension in the format: 12345-6789.
     • If the insurance address is a P.O. Box, use the last four digits of the P.O. Box number.
2. Finding the ZIP Code Extension (If Unknown):
   • Visit the USPS ZIP Code Lookup Tool (link available within iClinic).
   • Enter the insurance company’s full address.
   • Click “Find” to retrieve the ZIP+4 code.
   • Return to iClinic settings and input the full ZIP code with the extension.
   • Click “Save” to confirm changes.

4. Interpreting Eligibility Results

• Status: Finished (Blue)
  • Eligibility verified successfully.
  • Coverage details, benefits, co-payments, and insurance verification will appear on the right.
• Status: Rejected (Red/Pink)
  • Eligibility check failed.
  • Clicking the patient’s name will display the rejection reason (e.g., invalid insurance information).
• Status: Created (White)
  • No eligibility information was retrieved.
  • Indicates the insurer did not return any data at this time.

5. Best Practices for Eligibility Checks

• Verify Patient Information:
  • Ensure patient details (name, date of birth, insurance ID) are accurate before running the eligibility check.
• Check Insurance Settings Regularly:
  • Confirm that MRT IDs are updated, especially when adding new insurance companies.
• Document Rejections:
  • If eligibility is repeatedly rejected, document the rejection reasons and follow up with the insurance provider.
• Perform Eligibility Checks Before Appointments:
  • Run eligibility checks at least 48 hours before the appointment to address any issues in advance.

Let me know if you'd like any further adjustments or additional details!