The manual eligibility verification feature allows you to quickly check a patient's insurance coverage status and view detailed benefit information. This feature is available to all users on Base and Enterprise subscriptions.
How to Run an Eligibility Check
1. Navigate to the patient's profile
2. Click the "Check Eligibility" button
3. In the verification form:
Select or enter a Coverage / Subscriber ID or SSN
Click "Check Eligibility"
Understanding the Results
Summary View
The most recent eligibility check appears at the top of the list, displaying:
- Coverage status (Active/Not Found)
- Cardholder name
- Subscriber ID information
- ID used for verification
- ID returned by insurance (if different)
- Key financial information:
- Copay amounts
- Deductible
- In-Network Out of Pocket Maximum and amount spent
- Out-of-Network Out of Pocket Maximum and amount spent
Detailed View
Click "View Details" to see comprehensive information including:
Demographics
- Full patient name
- Date of birth
- Gender
- Complete address
- Social Security Number
Plan Information
- Plan name and type (HMO, PPO, POS)
- Plan effective dates
- Insurance contact information
- Group number
Benefits Information
- Service types covered
- Copay amounts
- Coinsurance rates
- Benefit descriptions
- Coverage limitations (monetary and quantity)
- Network providers
Eligibility Check History
All eligibility checks are recorded in the patient's profile, including both manual and automated checks. Each record shows:
- Date and time of check
- Insurance provider
- Eligibility status
- Option to view full details
Tips for Best Results
- Verify the subscriber ID is correct before running the check
- If the initial check fails, try using an alternate subscriber ID if available
- Review both the summary and detailed views to ensure you have complete benefit information
Need Help?
If you encounter any issues while running eligibility checks, please contact DocStation support for assistance via Chat or at support@docstation.co.