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Patient Eligibility

 

Patient Eligibility is a purchased upgrade to the Patient's ability. Eligibility will allow you to check the patient's insurance coverage within MacPractice. This feature will need to be activated once it has been added to your account. Go to Preferences by using the MacPractice menu in the top left corner. Navigate to Abilities in the sidebar and click Fetch License. You will be prompted to log out of MacPractice to activate the new abilities.

A MacPractice EDI Representative will provide a username and password from the clearinghouse.

Your insurance carriers will need to be set up with an Eligibility Payer ID or a Claims Payer ID to use the Eligibility feature within MacPractice.

Patient demographics are important when trying to use the Eligibility feature within MacPractice. Be sure that you have all the correct information within MacPractice.

Once all of the information has been verified, select an insurance reference and click Check Eligibility. The resulting popup will allow you to select a type of service. Press a letter on your keyboard to quickly navigate to an entry. Click Submit to see the patient benefits.

Health Benefit Plan Coverage will return generic benefit coverage information. If a payer does not offer eligibility for a certain specialty, generic benefit coverage will be displayed.

This window can be saved by pressing command p on your keyboard. Use the PDF menu to create a file or the print button to make a paper copy. These results are also saved in the eClaims ability of MacPractice. Simply open the Reports node to view a history. Use a sidebar search to find reports that are patient specific.

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