ELIGIBILITY CHECK GUIDE

The system has a function that directly makes users check eligibility of their admitted patients. This gives agency administrators and billers idea if the patient will cover claims that will only be covered by their insurance providers. The verification process performs a full update for patients, allowing authorized users to see any changes in HMO and PPS episode data. Also, the eligibility check reduces the incidents claim denial when the patient’s data is correct to start with.

Eligibility Check Location

The HHC Ultra Eligibility Check feature is located at the patient's Menu.

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It can also be found at the patient’s Basic Information section or the first step of the admission process. The button is between the Save and Reset button.

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Upon clicking on the button, the Search form appears. Users will need to have this filled-out before clicking on the Check Eligibility button. The Medicare eligibility results will show at the bottom of the search form box.

Opening the 270 and 271 Files The patient’s 270 and 271 file links will be available after the user gets the result of the eligibility data search. The two links are marked in blue and are under the corresponding category.

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The image below is an example of the X12 Health Care Eligibility & Benefit Inquiry transaction file. The user can view this upon clicking on View 270.

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The View 271 will show the X12 Health Care Eligibility & Benefit Response transaction.

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Auto-population of the Patient Basic Information from the 271

The system's 271 form is equipped with a Populate button that can automatically put in information on the Basic Information form that is also present in the 271.

The button for this function is at the upper left part of the page.

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Version Control #: DSL2019-2.3

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