Eligibility Tips and Tricks

After your eligibility verification is setup correctly, there are three main things that cause eligibility errors, they include:

1.  Eligibility payer ID not filled in

In Medisoft, go to Lists->Insurance->Carriers then select the insurance that is getting the error when running eligibility. Select the EDI/Eligibility tab and you should see an eligibility payer ID, you will get this from your clearinghouse.

2.  There is not an assigned eligibility receiver in Revenue Management

This is usually done when setting up your eligibility receiver however if you add new insurances after that you may need to do this step. Open Revenue Management under the configure option and then eligibility receivers and you will need to assign the receiver to each insurance.

3.  Your clearinghouse may require an eligibility enrollment

If you have tried each of these steps and it still seems to be having trouble double check with your clearinghouse to make sure that they do not require an enrollment agreement for the desired payer.