How do I complete insurance eligibility checks?
Through our new partnership with Emdeon, you can now check insurance eligibility for hundreds of payers directly from your EHR. Eligibility checks will automatically run up to seven days before a scheduled appointment. You can also manually run an eligibility check at any time.
Please note that the eligibility is only enabled for those practices with at least one provider who is identify-verified. Additionally, only those providers who have entered an NPI are authorized to run an eligibility check, or to have one run on their behalf.
Over 400 payers are currently supported, though eligibility checks may not yet run for some insurance companies. For a complete list of supported payers, please click here.
Completing and reviewing an eligibility check
Automated eligibility checks are run for any patient in the Schedule up to seven days prior to their appointment. You can review automated eligibility checks or run a manual check from either:
The Appointments tab on the Schedule
The Insurance section of a patient’s Profile
Checking eligibility within the Appointments tab
Within the Appointments tab of your schedule, click the View details button under the Eligibility column. Then, click Check.
Eligibility checks within the Appointments tab will be run under the provider the patient is scheduled with. Note: It can 2-3 minutes to complete the check
If the system is able to determine that the insurance is valid, a green check-mark will display. Select View details to review the insurance eligibility details.
Checking eligibility within the Insurance section of the patient Profile
Within the Insurance section of the patient Profile, click View details.
You will then need to click Check and select the provider you’d like to perform an eligibility check with.
Reviewing the eligibility check
If the insurance is valid, the following details will be available:
Last eligibility check
Payer name
Insurance ID
Select More details to review a complete page of subscriber and benefit information, including:
Copay
Deductible
Co-insurance
Insurance coverage dates
Resolving insurance eligibility errors
In certain instances, you may receive an error when completing an eligibility check. This may be due to:
An unsupported Payer (Note: Practice Fusion does not support all payers at this time)
A custom payer that is not linked to a known Payer in our list
Invalid or missing patient information
Invalid or missing insurance information
For more information on adding insurance to the patient profile, see How do I add Insurance/Payers?
If you see Fix when running an eligibility check, it indicates that some piece of the patient’s personal, insurance or guarantor information is missing or incorrect. Click on Fix to make the changes that are marked with an orange exclamation mark or are described in orange text, then save your changes. Close the window and click Check again.
While over 400 payers are currently supported, please note that Medicare and Medicaid are not currently supported for eligibility checks. You will see a green indicator for accepted payers or an orange indicator for unsupported payers when adding patient insurance to the Profile.
If you have added a custom payer to a patient’s Profile, the payer must first be linked to a known payer for eligibility checking using the Linked Payer field. Click into the field and search by payer name, then select the applicable option. Note: Not all known payers currently support eligibility.
A green Eligibility Supported indicator will display if the known payer currently supports eligibility checking. Note: When linking a custom payer to a known payer, the update will apply to all charts containing that custom payer.
Enabling Eligibility
Please note that the eligibility is only enabled for those practices with at least one provider who is identify-verified. In order to verify your identity, you must either:
Additionally, only those providers who have entered an NPI are authorized to run an eligibility check, or to have one run on their behalf. For instructions on entering your NPI number in your User Profile, please click here.
Eligibility Settings
To access Eligibility Settings, click Settings and select Eligibility.
Within Eligibility Settings, you can view which providers in your practice are verified to complete eligibility checks.
Additionally, if your practice would like to disable the eligibility feature, any administrator can navigate to Eligibility Settings and uncheck the box to Perform eligibility checks. Please note that disabling this feature will prevent you from running both automatic and manual eligibility checks.
