Eligibility
Note: Not all insurance companies support Eligibility Verification. If it does not work, please confirm with the insurance company.
Eligibility Verification Screen
The Eligibility Verification can tell the user whether a patient is eligible or not for a certain insurance plan.
If the patient’s information is already on the Rx Processing screen the system will automatically enter some of the information in the corresponding fields. If not, you may enter in the information manually.
All E1 checks require the use of the patient's social security number in place of Cardholder ID.
The full number or last four digits must be used without any dashes. When running Eligibility for an E1 plan, make sure the group field is blank.
To run a patient eligibility query, you have to select the following plan:
E1_COMM_PL for Commercial plan queries through PowerLine (Blue Cross, Caremark, etc.)
Older versions of BestRx may show the options below, but going forward, PowerLine will be the only method for running eligibility checks. Ensure the pharmacy software is updated to version V6.5.0917 by checking for program updates.
E1_COMM_RH
E1_MEDD_RH
E1_EMDEON
When the required information is entered, click the ‘Transmit’ button or press the "Enter" key when the ‘Transmit’ button is highlighted to transmit the eligibility verification.
Bulk Patient Eligibility Request
A new right-click option in the Patient Listing and Patient Usage reports allows users to perform a Bulk Eligibility Check for multiple patients.
After selecting patients and choosing the new right-click option, the Bulk Eligibility Check screen will open. Patients can be selected or unselected as needed, and the eligibility check method can be chosen.
After the eligibility check is complete, results will be displayed in status. New plans are automatically added to the patient file. Plans highlighted in green are not in the database and will be added, blue indicates the plan already exists in the database, and red means no match was found.
Plan Finder
Another way run and eligibility check is by using the ‘Plan Finder’ button in the Patient File (F3), then selecting Insurance Plans.
In the Plan Finder screen, the pharmacy will select ‘Commercial’ and provide the full social or last 4 digits of the social security number for the patient and select ‘Find Plans’ to search patient insurance information.