11 Eligibility Management

Use this workflow to manage eligibility in Oracle Health Patient Administration. This workflow enables you to view additional eligibility information sent from the payer once eligibility has been submitted. Eligibility can be submitted manually or through a Millennium Platform Operations job. The Eligibility workflow displays information from the payer and enables you to review patient insurances before the associated visit occurs to ensure that the health plans are active. Reviewing insurances in advance also allows you to collect necessary payments sooner. This workflow also enables you to verify that the correct health plans are associated with the correct claims and that health care facilities receive the correct payments.

• Submit Eligibility Response
  Complete the following steps to submit an eligibility response:
• View Coverage Status
  Complete the following steps to view coverage status information:
• View Patient/Subscriber Information
  Complete the following steps to view patient or subscriber information:
• View and Update Discrepancies
  In the Common Financial Clearance interface, if any differences exist between the information submitted in the request and the information the payer has on file, a discrepancy alert is displayed. Information contained in Oracle Health Patient Administration is displayed in the Current row,while the response from the payer is displayed in the Response row.
• Review Messages and Alerts
  Complete the following steps to review messages and alerts:
• Review Support Information
  Complete the following steps to review the support information:
• Select and View Benefit Information
  Complete the following steps to select and view benefit information: