How to Confirm Client's Insurance Eligibility

Ly Do

Updated January 31, 2024 15:07

Being able to check your client’s eligibility for insurance before committing to delivering your service is key in reducing the amount of time calling insurance companies and saving your clients tremendous hassles. Through the Eligibility tool at OnCall Health, you will now be able to check their insurance eligibility at your own convenience.

If you do not currently have this feature, please contact your Account Manager directly for more information.

With this Eligibility tool, providers will be able to:

Verify the eligibility of a client
Check their eligibility status in real time
Get a history of occasions you have checked their eligibility

Please note: You will need to provide OnCall Health with your National Provider Identifier and your full legal name in order to use this feature.

Step 1: Log into your account and navigate to Roster
Step 2: Select the appropriate Roster contact and Navigate to the Insurance tab
Step 3: If this is the first time you check one particular client’s eligibility for insurance, you will need to create their insurance profile. Click on “Create new profile”.
The left column is asking for information about the client, please ensure that information entered here is according to their legal documents.

The right column is asking for information about the Payer and Service provided. Please enter the name of the Payer as it shows in the client’s insurance card and choose the correct option in the dropdown list.

For Service Type, the default option is “30- Health Benefit Plan Coverage”. However, you can choose the correct option in the drop down list sorted by standard insurance codes.

Once you have completed the information, the Save button will turn blue and become clickable. Click on Save
You can now verify the eligibility of this client by clicking on “Verify Eligibility”. If you make a mistake while entering their information, please click on “Edit Information” to change the information before verifying the eligibility.
The system will take a few moments to verify their eligibility. Please do not refresh your page until you get the result.
Once the verification process is complete, you will get detailed information of the eligibility inquiry. Click on the “x” button to close the tab and see the status of their eligibility.
You will get the result along with information on the last time you have checked their eligibility. Clicking on “View result” will bring you back to the Eligibility Inquiry tab.
You’re done! Now you know if this client is eligible for insurance using your service.
If you want to view the history of how many times you have checked this client’s eligibility status, click on “View eligibility history”.
From here, you should be able to get an overview of how many times you have checked their eligibility, what was the status, who is their payer and what is their insurance package. Clicking on the row will give a detailed report on their Eligibility Inquiry at that occasion.

Please note: In case the client has 2 insurance packages, you can add both packages and check for their eligibility status by clicking on the “Add another profile” button and enter their information accordingly.