Change Healthcare: Eligibility Checks [Not Available]

As an alternative, we are releasing a direct integration with ClaimMD to offer eligibility checks and claims management. Please subscribe to the linked Portal Cards to be notified when the ClaimMD integration is available for your plan.

Updating Insurance Eligibility Settings

For users who already have Change Eligibility Checks enabled. This integration is not open for enrollment.

After Change Eligibility Check integration is enabled, navigate to Settings (top right gear icon) > Settings > Business > Insurance. You will see a setting for "Request Insurance Availability Check."

Note: Manual eligibility tracking is still critical for organizations who choose not to integrate with Change. If both manual and automatic insurance eligibility checks are available, there will be no difference between the two.

If "Request Insurance Eligibility Check" is turned OFF, click "Edit" to edit the Insurance Settings. As soon as you toggle this setting ON and click the blue "Save Changes" button, Eligibility checking will be enabled in ALL client profiles.

Run an Insurance Eligibility Check within Healthie

For users who already have Change Eligibility Checks enabled. This integration is not open for enrollment.

Navigate to Clients (left navigation sidebar) > Client Name (e.g. Demo Client 1) and scroll down to "Insurance Eligibility" box. Click on the blue "Check Eligibility" button after entering in client's insurance details.

In the event that the eligibility check succeeds, look for the following green success banner.

In the event that the eligibility check fails, you will receive a red error banner. Navigate to Actions tab > Insurance (blue toggle box). You will see a banner that indicates what specific fields requirements need to be present to run an eligibility check. You should also be able to dismiss the banner on your end. Please note that a "Missing Information" banner will appear if the provider does a check and the response has field errors.

Prevent Unauthorized Transactions by Organization Users

For users who already have Change Eligibility Checks enabled. This integration is not open for enrollment.

In the event that providers conduct checks without permission from the organizational administrator, your organization may incur charges from Healthie. To prevent this, the organizational admin can add permissions to prevent unauthorized transactions and either enable or disable the ability for users to run eligibility checks.

Navigate to Organization > Members. Click on the [...] that appears when you hover on a member's name, and select Edit Settings > Permissions (left side navigation bar). Scroll down to Billing section.

If the user has access to billing, they should automatically have the "Can request eligibility checking" permission enabled (checked).

Auto Notify Provider when Insurance Eligibility is Expiring

For users who already have Change Eligibility Checks enabled. This integration is not open for enrollment.

Providers may forget to check when a client's insurance expires or is updated, and collecting the updated information or context may cause delays in billing.

When "Expiry Notifications" is selected:

• If Expiry information is available, an email will be sent to you (the provider) 2 weeks before insurance expiration
• The email will include the insurance expiration date
• From here, you can message your client and/or send them the Insurance Billing form for completion. If the policy is expiring, or if the provider wants new information, you can send an automatic insurance form completion request to the client via email. Navigate to Clients (left navigation sidebar) > Client Name (e.g. Demo Client 1) and scroll down to "Insurance Eligibility" box. The provider should be able to click on [...] and see a drop-down menu. One of the menu options provide the ability to "Request Client Insurance Form." Once clicked, an automatic email with a request to provide insurance will be sent to the client. The provider will then see a banner that confirms that the email has been sent.
• Alternatively, learn how to manually request a client (or multiple clients) to submit the Insurance Form within Healthie here.

When "New Insurance Added Notifications" is selected:

• If a client's insurance is updated by the client via form, an email will be sent to the assigned provider
• The email will include the insurance expiration date