Eligibility

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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.

To run a patient eligibility query, you have to select one of the following plans; E1_COMM_RH for Commercial plan queries through Relay Health (Blue Cross, Caremark, etc), E1_MEDD_RH for government queries through Relay Health (Medicaid/Medicare, etc), or E1_EMDEON for all queries through Emdeon/Change Healthcare (only if using them as your switch vendor instead of RH). 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.

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.

Not ALL Insurance companies support the Eligibility Verification. Please check with the Insurance company if the Eligibility Verification does not work.