View Coverage Status

Complete the following steps to view coverage status information:

1. In the Eligibility Details dialog box, view the coverage status below the patient name. Select it to view additional details.
   1. Active Coverage or Active Multiple Coverage
   2. Inactive or Noncoverage
   3. Payer Rejection, Payer Cannot Process, or Contact Other Entity
2. If the coverage status is inactive, no coverage, or payer rejection, the Verify Status field is automatically updated to Yes Follow Up. Payers with a verify status of Yes Follow Up are qualified for the Incomplete Verification Work Queue.
   1. If manual follow up is needed because of inactive coverage, contact the payer and update the Verify Status accordingly.
   2. Select Cancel to close Eligibility Response and update the insurance information using information from the patient or payer.
   3. Resubmit insurance for eligibility.
3. If the coverage status is Active Coverage or Multiple Coverages, no further action is necessary.

   Note:

   The Historical Response alert is only displayed if you enable the Historical Processing option in the associated domain. If this option is disabled, the Historical Response alert is not displayed.

   Note:

   The Verify Status value for the health plan is automatically updated to Verified if the eligibility status is returned as Active. If the eligibility status is returned as Inactive, No Coverage, or Payer Rejection, the status is updated to Yes Follow Up. The following values are available for the Verify Status field and can be manually selected after eligibility is checked on the health plan:

   • Denied: Manually updated value if patient's insurance is denied
   • Not Applicable: Manually updated value used if insurance verification does not apply to the specific health plan
   • Pending: Manually set value if patient's insurance information is pending
   • Required: Default value for the Verify Status field
   • Verified: Indicates successful eligibility transaction and that patient has eligibility coverage
   • Error: Manually updated status for insurance if patient's insurance information is in error
   • Yes Follow Up: If eligibility submissions come back as inactive coverage