How to Use Eligibility Verification in EHR/Practice Mate

Eligibility Verification is a paid feature in Office Ally that allows you to check a patient’s insurance eligibility and benefits directly from their chart or appointment. This feature is available in Service Center, Practice Mate, and EHR 24/7.

.This article will walk you through how to set up and use Automated Eligibility and Manual Eligibility Verification.

Before We Begin

To use Eligibility Verification, your insurance payer must be linked to a recognized Health Plan Eligibility Name in Office Ally. If the payer cannot be found during setup, eligibility verification will not be available for that payer. Also, your account must have administrative rights to perform these steps.  

Steps to Activate Automated Eligibility

1. Navigate to Automated Eligibility Settings

• In EHR 24/7, go to the Manage Office tab and click Automated Eligibility Settings under the Admin section.

• In Practice Mate, go to Manage Office, then Company Settings, and select Automated Eligibility Settings.

2. Activate Automated Eligibility

• Click the Activate button to enable automatic eligibility checks for each scheduled patient appointment.

• To turn this feature off, click Deactivate.

3. Configure Time Zone and Frequency

• From the Time Zone drop-down, select your correct time zone.

• Under Eligibility Check Frequency, choose Each Appointment (this is currently the only available option).

• Click Update to save your settings.

Linking Insurance Payers to Eligibility Plans

1. Access Insurance List

• In EHR 24/7 or Practice Mate, go to Manage Office, then List Maintenance, and then Insurance.

2. Edit Payer Information

• Click Edit next to the Payer you’d like to link.

3. Select the Eligibility & Benefit Payer Name

• In the Eligibility & Benefit Payer Name section, click Browse.

• Use the pop-up window to search for a corresponding Health Plan Eligibility Name.

• Click Select to link the plan to the payer.

• If the plan cannot be found, it is not currently supported for eligibility verification.

• Click Update to save changes.

Activating Eligibility for Individual Patients

1. Access Patient Information

• In EHR 24/7, go to Patient Charts, search for the patient, and click the pencil icon under Edit Dem.

• In Practice Mate, go to Manage Patients, search for the patient, and click their name.

2. Link the Eligibility Payer Name

• Click on the Insurance tab.

• Under Eligibility & Benefits Insurance Information, locate Eligibility & Benefit Payer Name.

• Click the ellipsis (…) button to search for and select the appropriate health plan.

• Click Update to save.

Using Automated Eligibility from Appointments

1. View Eligibility Status

• In the Appointments section, open the Detail View.

• The Automated Eligibility Status column will display the status:

Scheduled: Eligibility has not yet been checked.

Processed: Eligibility has been verified.

2. Verify Now (Manual Trigger)

• Click Verify Now next to an appointment with a Scheduled status to run an immediate eligibility check.

3. View Response

• Once processed (typically 24 hours before the appointment), click View Response to see the verification results in a pop-up window.

Using Automated Eligibility from Appointments

If you prefer to verify eligibility manually or your practice does not use automated checks, you can access the tool in two ways:

1. From Patient Insurance Information

• In EHR 24/7 or Practice Mate, open the patient’s record.

• Under the Insurance tab, click Verify Eligibility and Benefits to launch the verification pop-up.

2. From Appointments

• In the Appointments view, click Verify Now for any scheduled appointment to manually check eligibility.

By following these steps, you can easily activate, configure, and use the Eligibility Verification feature in Office Ally’s EHR 24/7 and Practice Mate, ensuring accurate benefit and coverage information before each patient visit.

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